Transcript

1.
“EFFICICACY OF SIRAVYADHA WITH AND
WITHOUT VIRECHANA IN SHARAD RUTU-
A COMPARATIVE STUDY.”
BY
Dr. RAVIKUMAR B. PATIL., B.A.M.S
Dissertation submitted to the Rajiv Gandhi University of Health
Sciences, Bangalore, for the partial fulfillment of Degree
AYURVEDA VACHASPATI
DOCTOR OF MEDICINE (AYURVEDA)
IN
PANCHAKARMA
Under the guidance of
Dr. SHYLAJAKUMARI R.. MD (Ayu.)
Asst. Professor
Department of Post Graduate Studies in Panchakarma,
Government Ayurvedic Medical College Bangalore
DEPARTMENT OF POST GRADUATE STUDIES IN PANCHAKARMA
GOVERNMENT AYURVEDIC MEDICAL COLLEGE
DHANWANTARI ROAD, BANGALORE – 560009
2010-2011

2.
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled “Efficacy of
Siravyadha with and without Virechana in Sharad rutu -A
Comparative study” is a bonafide and genuine research work carried out
by me under the guidance of Dr.Shylajakumari R., Asst. Professor, Dept
of PG studies in Panchakarma, Government Ayurvedic Medical College,
Bangalore.
Date: Signature of the candidate
Place: (Dr. Ravikumar B. Patil)

3.
Department of Post Graduate Studies in Panchakarma
Government Ayurvedic Medical College
Bangalore - 560009
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “Efficacy of Siravyadha with
and without Virechana in Sharad rutu -A Comparative study” is a
bonafide research work done by Dr.Ravikumar B. Patil . in partial fulfilment
of the requirement for the degree of “AYURVEDA VACHASPATI” – MD
(Ayurveda) in Panchakarma of the Rajiv Gandhi University of Health
Sciences, Bangalore.
I recommend this dissertation for the above degree to the University for
Assessment and approval.
Dr. Shylajakumari R.M.D (Ayu)
Asst. Professor,
Dept. of PG studies in Panchakarma
GAMC, Bangalore - 09

4.
ENDORSEMENT BY HOD & PRINCIPAL
This is to certify that the dissertation entitled “Efficacy of Siravyadha with
and without Virechana in Sharad rutu -A Comparative study” is a
bonafide research work done by Dr.Ravikumar B. Patil . In partial fulfilment
of the requirement for the degree of “AYURVEDA VACHASPATI” – MD
(Ayurveda) in Panchakarma under the guidance of Dr. Shylajakumari R.,
Asst.Prof., Dept of PG studies in Panchakarma, Government Ayurvedic
Medical College, Bangalore.
Dr. Shalini C. Eli, MD (Ayu.) D.N.Y. Principal
Prof. & Head of the Department, Govt. Ayurvedic Medical College,
Department of P.G. Studies In Panchakarma, Bangalore.
Govt. Ayurvedic Medical College,
Bangalore.

6.
ACKNOWLEDGEMENT
It gives me immense pleasure to offer my sincere thanks to all those
who have rendered their wholehearted support, guidance and Co-operation in
completing my work.
I express my deep hearted reverence to that divine source. I bow my head to the
lotus feet of “Lord Dhanvantri” with whose showering of blessings this task was
ventured without any hindrances.
It’s my great pleasure to express my deep gratitude towards my
adorable guide, Dr.Shaylaja Kumari R., Asst. Professor, for her incessant and
untiring guidance with all the diligence. Her benevolent teaching & critical
suggestions had given me a propitious direction to accomplish this work in all aspects.
I am also thankful to my H.O.D, Dr. Shalini C. Eli, for being a
supporting hand in my work.I am also thankful to Dr. Shridhara B. S.
former.H.O.D.for his encouragement and critical suggestions..
I am grateful to Dr. H.T.Srinivas MD (Ayu) former principal,
G.A.M.C., Bangalore, for his support and guidance in carrying out this work.
I express my deep gratitude to Principal of G.A.M.C, Bangalore Dr .S.G.Mangalgi.
I am especially thankful to teachers of “Department of Panchakarma”
Dr.Janaki, Dr.Santhosh.L.Y., Dr.V.M.Hugar, Dr.Shaila Gurappa, whose constant
encouragement and useful suggestions helped me throughout the study tenure.
I pay my obeisance to my all family members, my parents Shri B. S. Patil and
Smt C. B. Patil being my inspiration and support in every step of my life. I also thank
my grandparents Shri. S.R.Patil and Smt. M.S.Patil. and My brothers Ramesh and
Rohit.

7.
I am especially thankful to Dr. Somnath Gore, Dr.Pooja B.A. and
Dr. Manjunath Kanti for their support and cooperation.
I am very much thankful to my seniors Dr.Usha,Dr.Ashwini Kulkarni,
Dr.Rajani Ramesh, Dr.Divya, Dr.Salma, Dr.Smina, Dr.Sandeep, Dr.Somnath &
My special thanks to my department colleagues and friends, Dr.Pooja
Dr,Basavjyoti,Dr.Sumit,DrVijaya,Dr.Srinivas, and also thankful to my juniors
Dr.Rashmi,Dr.Vanishri,Dr.Manjunath,Dr.Shridhar,Dr.Nandakishore,Dr.Muku
nd Dr.Kamalesha and all other post graduate scholars for their needful support to
fulfil this task.
I thank library, hospital & office staff, R.M.O. Dr. Nagraj, Physicians, and
all my patients for their kind support during my study.
I take this opportunity to appreciate the generous co operation offered by
volunteer by being highly obdient during my study period .
I take all my effort to laud Dr. Raghavendra, Statistician, without whose
help whole of my work would have looked meaningless. I am extremely grateful to
my printer who has printed and bounded my work legibly and neatly.
Last but not least, I express my thanks to each and every person who have
helped me directly & indirectly in accomplishing this task without any blemishes,
with apologies for my inability to identify them individually.
Dr.Ravikumar B. Patil.

10.
ABSTRACT
“EFFICACY OF SIRAVYADHA WITH AND WITHOUT VIRECHANANA
IN SHARAD RUTU –A COMPARATIVE STUDY”
Preserving the Health is one of the main endeavors of Ayurveda. For this
Ayurveda describes in detail about various seasonal regimens, which harmonize
the doshas disturbed by the effect of seasons. Disharmony of dosha and dushyas is
the prime cause for the onset of disease
Modern way of living with its inherent stress and unwholesome lifestyle
such as working during night, sleeping during day, food habits and ignorance of
seasonal regimen for healthy living causes doshas to become enormously vitiated
and causes a number of diseases.
.According to classics, both Pitta and Rakta naturally get aggravated
during Sharad rutu. If this disharmony is not correct properly through seasonal
regimen, it will lead to a plenty of diseases such as daha, kandu, kushta, visarpa
etc.
Raktmokshana has been prescribed as the principal seasonal regimen to
correct the disharmony of pitta and rakta caused in Sharat rutu. Chakrapani opines
that Raktamokshana should be after Virechana.Sharangdhara said that in sharad
rutu rakta gets aggrevated naturally so do the raktamokshana but there is no
specification regarding virechana before that. Whereas Bhavprakasha and
yogratnakar stated that it should be siravyadha.
So far a number of research work have been conducted on siravyadha in a
variety of diseases but Rutushodhan a form of preventive treatment remains
greatly ignored.In the present study an effort is being made to assess the
importance of siravyadha as a form of rutushodhan and need of the virechana

11.
before raktamokshana with the objective of keeping diseases of modernity in
check.
Methods:A total of 30 subjects having the pittaprakopaka laxanas were included .
As per the inclusion and exclusion criterias, the subjects who fulfill the criteria
were selected and randomly divided into two groups consisting of 15 patients in
each group. Group A: Jeerakadi Churna was administered till Niramavastha
followed by arohana krama snehapan with Murchit goghrut until getting samyaka
snigdha laxanas.Abhyanga with tila taila followed by parisheka sweda(Ushnodak)
carried out for three days.On third day virechana yoga was
administered.Depending upon the shuddhi the samsarjana karma was planned.
After two days of completition of samsarjana karma snehapan with murchit
goghrit was done for two days. On the day of siravyadha abhyanga and parisheka
sweda was done.
Group B: Jeerakadi Churna was administered till Niramavastha followed
by snehapan with murchit goghrit for two days. On the day of siravyadha
abhyanga and parisheka sweda was done.
Subjective and objective parameters were assessed before and after shodhana.
Result: The result was found highly significant in terms of clinically and
statistically.
Conclusion: Clinically and statistically this study was shown good results in
subjective and objective parameter in both the groups.
Siravyadha followed by virechana and siravyadha alone are beneficial to
eradicate the vitiated pitta dosha . But the siravyadha followed by virechana is
better than siravyadha alone.
Key words: Virechana, Siravyadha, Sharad rutu, Pittaprakopa.

18.
Introduction
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 1
INTRODUCTION
Ayurveda an ancient Indian wisdom stands apart from the rest of medical
fraternity with its holistic and encompassing approach towards the prevention of
disease and disease management. Ayurveda has been in vogue since the Vedic period
or even earlier. It emphasizes on the maintenance and promotion of health as well as
curing of diseases.
xuÉxjÉxrÉ xuÉÉxjrÉ U¤ÉhÉqÉç AÉiÉÑUxrÉ ÌuÉMüÉUmÉëzÉqÉlÉ: |
This unique science is based on the fundamentals of sankya philosophy; it
reflects Indian culture civilization and heritage. This science of antiquity helps in
upholding the physical, mental and social health of living beings. Health of any
individual depends on proper diet, way of living, personal behaviour and hygiene.
Any lacuna in this routine may lead to disturbance of homeostasis and causes
diseases.
The health is basic need for all human being to achieve the four pursuit of life
viz. Dharma artha kama and moksha.
kÉqÉÉïjÉïMüÉqÉqÉÉå¤ÉÉhÉÉÇ AÉUÉåarÉÇ qÉÑsÉÇ E¨ÉqÉqÉç|
Human being is an integral part of an universe.The changes occurring in external
environment affects to the body accordingly. In Ayurveda the changes occurring in
external environment has been divided into six rutus which is true till to the
date.These environmental variations ,affects the human being ,leading to disharmony
of the doshas which are the prime cause for the manifestation of diseases.

19.
Introduction
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 2
Maintaining the health in healthy is one of the main endeavour of Ayurveda.
Preservation of health and prevention of diseases is an essential thing for human
being. As well said” prevention is better than cure”. For this Ayurveda describes in
detail about various seasonal regimens as per the season,which hormoize the doshas
disturbed due to seasonal variations.
In classics it has been told that on regular interval ;purification of body by
purificatory measures keeps person healthy ,delays ageing and avoid
obesity,diabetes,skin diseases, anaemia,digestive disorders,which are the burning
problem of present era.
According to classics both pitta and rakta gets aggravated during sharad rutu. If this
is not corrected properly through seasonal regimen, it will lead to plenty of pitta and
rakta induced diseases such as daha ,kandu, kushtha, visarpa, kandu, mukhapak etc.
In present era modern way of living with its inherent stress and unwholesome life
style such as working during night, sleeping during day, wrong food habits and
ignorance of seasonal regimen of person causes doshas to become enormously
vitiated and manifestation of various diseases. Health has become secondary to
money until disease strikes, once health is disturbed people are forced to spend both
money and time in an effort to regain the lost health.
Panchashodhanas are the integral parts of Ayurveda.These therapies are
comprehensive method of internal purification of body. These are designed to
eradicate the vitiated doshas and to maintain the normalcy and equilibrium of the
dosha dhatu mala.

20.
Introduction
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 3
Virechana is one of the prime purificatory measure; for the elimination of vitiated
pitta dosha
ÌuÉUåcÉlÉÇ ÌmÉ¨ÉWûUÉlÉÉqÉç
There are different measures for elimination of vitiated rakta such as shrunga, jalouka,
alabu which eliminate the dushit rakta from limited area. But siravyadha is the unique
procedure to let out the vitiated blood from whole body.
ÍxÉUÉ xÉuÉÉÇïaÉzÉÉåÍkÉÌlÉ |
So far many research works has been carried out regarding the role of purificatory
procedures in curative aspects. But purificatory measures as a preventive method
remained greatly ignored; even though their importance had been underlined by
Ayurvedic classics.
Doshas which are the prime cause for the disturbance of health, if maintained in
equilibrium state, through purification on regular interval, will be helpful for the
preservation of health.
In the present study an effort is being made to assess the importance of siravyadha as
a form of rutushodhan and need of virechana before raktamokshana.
So with this view the work has been carried out under the heading “EFFICACY OF
SIRAVYADHA WITH AND WITHOUT VIRECHANA IN SHARAD RUTU-A
COMPARATIVE STUDY.”

21.
Objectives of study.
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 4
OBJECTIVES OF STUDY:
1) To study the effect of siravyadha with virechana in sharad rutu.
2) To study the effect of siravyadha without virechana in sharad rutu.
3) To compare the efficacy of siravyadha with and without virechana in sharad
rutu.

22.
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 5
PROCEDURE REVIEW
VIRECHANA KARMA:
Historical review of virechana karma:
Purana kala:
In Manu smrithi, it is stated that bath is done after the completion of
vamana and virechana.
In the text Vinaya pittaka, mentioned that virechana was given to Bhagwan Buddha
by inhaling some powdered medicine sprinkled over uthplapatra. In Agni purana it is
told that virechana as best treatment for the diseases caused due to Pitta.Trivrutta as
best virechaka dravya. It is indicated in urdhwaga rakta pitta, jwara, hridroga.1,2
Samhita and Sangraha kala:
Charaka samhitha:
Virechana dravyas, virechanaopaga dravyas, sangraha vidhi and virechana procedure
is explained in sutrasthana.3,4,5
Different types of virechana kalpas are explained in kalpa sthana6
.
Yogyas-ayogyas, samyak, heena and atiyogas of virechana karma 7
, samsarjana
krama8
, vyapath and its treatment are explained in siddhisthana9
.
Table No.1: Chapters and contents related to Virechana in Charaka samhita.
Sthana Ch. No. Name of chapter Content
Sutrasthana 2 Apamargatanduliya Virechana dravya
4 Shadvirechanashateeya Shadvirechanaashraya
Virechanopaga
15 Upakalpaniya Virechana procedure
Siddhisthana 2 Panchakarmiyasiddhi Virechana

25.
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 8
SHAREERA –
Anatomy and Physiology in relation with virechana:
Srotas
The function of the jatharagni is to digest the food. it is situated in between
Amashaya and Pakwashaya.
Amashaya is Mula of Annavaha srotas (food conducting channel),. .
Pakwashaya and sthula guda are Mula of Purishavaha srotas.
According to Charaka, Koshta has the following synonyms-
- Mahasrotas (the great channel)
- Shareera Madhya (the mid part of the body)
- Mahanimna (the great cavity)
- Amapakwashaya (the stomach including the small intestine and large Intestine)
- Abhyantara roga marga (internal pathway of disease).
Here the Amapakwashaya indicate the combination of Amashaya and
Pakwashaya which is responsible for the complete process of digestion.By this we can
understand koshta comprises of two srotases, viz, Annavaha Srotas and Pureeshavaha
Srotas.
The digestion, assimilation, and separation of ingested food into Sara
(essence) and Kitta (waste) occurs in these Srotas. The Kitta portion further get
divides into purish and mutra as per its composition.Formation of purisha takes place
in the Pureeshavaha Srotas by the Purishadhara Kala and it is excreted through the
Guda marga.
Anatomical structures
• Aamashaya

26.
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 9
• Grahani
• Kshudrantra
• Sthulantra
• Pakwashaya
• Guda
The Sthulantra follows with Kshudrantra (small intestine) commences from
the Amashaya. The first part of the Antra is said as Grahani which is the seat of
jatharagni.
The anatomical part after Grahani is Pakwashaya which restrain the food that has
already been digested. The lower portion of the Sthulantra is known as Guda. Its
function is to expel the Anna-Kitta along with Malas. 21
Ahara Parinamana (Paka) krama –
Table No.4:Factors and their function involved in Digestion.
Factor Function
Pran vayu Carry food from mouth to aamashaya
Kledaka kapha Ann sanghat and kledan
Jatharagni Paka
Saman vayu Stimulation of agni and movement of
food
Ahara Parinamakara Bhavas, viz., the Ushma, Vayu, Kleda, Sneha, Kala and
Samyoga plays important role in digestion of ingested food.

27.
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 10
The consumed food is brought into the Aamashaya by Vayu (Prana Vayu),
there the Samana Vayu stimulates the jatharagni and helpful for the proper movement
of food which facilitates the Paka Karma. By the help of Kleda and Snehabhavas, the
food will get softened beginning from Amashaya. The digestion or Paka Karma
depends upon the Kala, which is responsible for the preceding of vipakas of Paka
Karma.
The Samana Vayu which is situated in koshta accomplishes movement of the
food particles.It also does the Vivechana Karma of Sara and Kittabhaga. Munchana
Karma i.e. the propulsion of food particle from one segment to another segment is
done by SamanaVayu throughout the Amashaya and Grahani up to Pakwashaya. The
Samana Vayu by its influence towards the rapid movement and pressure alteration
helps in absorption of Sarabhaga through the intestines and Kittabhaga is propelled
forwards into Purishadhara Kala for the formation of Malabhaga.
Once the Kittabhaga enters into the Pakwashaya it gets converted into solid
form by the action of Apana Vayu and it is excreted through the Gudamarga.
Different factors influencing the formation of Purisha 22
:
The factors influencing for the formation of purisha are Pittadhara Kala, Purishadhara
Kala, Pakwashaya, Agni and Vayu.
1. First ahara undergo for the jatharagnipaka i.e., intestinal digestion. The term has
been used as adhoamashaya by Chakrapanidatta.
2. The Bhutagnipaka postulates the view that the end product of jatharagnipaka.

28.
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 11
According to Vagbhata, the separation of Sara bhaga or nutrient fraction of the food
takes place after the completion of Bhutagnipaka.
Chemical reactions involved in jatharagnipaka occur in adhoamashaya, those
implied by Dhatwagnipaka resemble in general the metabolic reaction that takes place
in the yakrit or liver.
3. The remaining ingredients of intestine, such as ammonia, urea, uric acid etc
are seen to be derived from the blood and they represents the outcome of metabolism
or the kitta aspect of the dhatwagnipaka.
4. The Katu bhava of avasthapaka describes the events in the Pakwashaya or large
intestine leading to the formation of faeces and gases.
As the intestinal contents reach the large intestine, the process of absorption with the
exception of water, is normally completed. In the large intestine more of water and
salts are absorbed. The material left over is converted in to faeces which leave the
body.
MODERN VIEW 23, 24
Wall of GIT:
1) Mucous layer – Has 3 layers- epithelial lining, lamina propria and muscularis
mucosa.
2) Sub mucous layer – Consists of collagen fibers, elastic fibers, reticular fibers and
few cells of connective tissue. Blood vessels, Lymphatic and Nerve plexus.
3) Muscular layer – Skeletal and smooth muscle fibers.
4) Serous or Fibrous layer – formed by connective tissue and meso epithelial cells.
Nervous system of GIT
Intrinsic Nervous system – 2 Types: Mesenteric Nerve Plexus

31.
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 14
(Duodenum 12
times per min,
Ileum 8 times per
min)
of the small intestine; mixes chyme with digestive juices and
brings food into contact with the mucosa for absorption.
Migrating motility
complex (MMC)
A type of peristalsis consisting of waves of contraction and
relaxation of circular and longitudinal smooth muscle fibers
passing the length of the small intestine; moves chyme toward
ileocecal sphincter.
1. Regulation of intestinal secretion and motility – The most important regulators of
small intestinal secretion motility is enteric reflexes and digestive hormones.
Parasympathetic impulses increase motility and sympathetic impulses decrease the
motility.
2. The first remnants of a meal reach the beginning of the large intestine in about 4
hours.
Large intestine:
1. The large intestine extends from the ileocecal sphincter to the anus. It regions
include the caecum, ascending colon, transverse colon, descending colon, sigmoid
colon, rectum and anal canal.
2. The mucosa contains the absorptive cells (for water absorption), globet cells
(secrete mucus) and muscularis consists of teniae coli and haustra.
3. Mechanical movements of the large intestine include haustral churning, peristalsis
and mass peristalsis.

32.
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 15
4. The last stages of chemical digestion occur in the large intestine through bacterial
action. Substances are further broken down, and some vitamins (Vit. K, Vit. B) are
synthesized.
Table no 7: Digestive Activities in the Large Intestine
Structure Activity Functions
Lumen Bacterial activity Breaks down undigested carbohydrates
proteins, and amino acids into products that
can be expelled in feces or absorbed and
detoxified by liver, synthesizes certain B
vitamins and Vit. K
Mucosa Secretes mucous
Absorption
Lubricates colon and protects mucosa
Water absorption solidifies feces and
contributes to the body’s water balance
solutes absorbed include ions and some
vitamins.
Muscularis Haustral
churning
Peristalsis
Mass peristalsis
Defecation reflex.
Moves contents from haustrum to haustrum
by muscular contractions.
Moves contents along length of colon by
contractions of circular and longitudinal
muscles.Forces contents into sigmoid colon
and rectum.Eliminates feces by contractions
in sigmoid colon and rectum.
Absorption of Faeces formation in the large intestine:

33.
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 16
By the time chyme has remained in the large intestine 3-10 hours, it has become solid
or semisolid because of water absorption and is now called feces. Chemically, feces
consist of water, inorganic salts, and sloughed-off epithelial cells from the mucosa of
the gastrointestinal tract, bacteria, and products of bacterial decomposition,
unabsorbed digested materials, and indigestible parts of food.
The Defecation Reflex:
The defecation reflex occurs as follows:
In response to distention of the rectal wall, the receptors send sensory nerve
impulses to the sacral spinal cord.
Motor impulses from the cord travel along parasympathetic nerves back to the
descending colon, sigmoid colon, rectum, and anus.
The resulting contraction of the longitudinal rectal muscles shortens the
rectum, thereby increasing the pressure within it.
This pressure, along with voluntary contractions of the diaphragm and
abdominal muscles, and parasympathetic stimulation, opens the internal anal
sphincter.
VIRECHANA
The process by which the vitiated doshas are eliminated through the
adhomarga, guda marga (lower out let), is called ‘Virechana..Virechana in broader
term denotes both vamana and virechana.25
.
Vyutpatti:
The derivation of the word Virechana is as follows,
Vi – Upasarga (Prefix)

34.
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 17
Richir – Rich Dhatu (Root) – samparka viyogayo (kavikalpadruma)
Lyut – Pratyaya (Suffix)
– means Mala Nissarana, i.e., elimination of malas by the body
through any route.Hence widely used in elimination of doshas e.g mutra virechana,
shirovirechana .As it gives meaning of elimination of malas commonly used for both
vaman and virechana.
According to Shabdakalpadruma,
Rechana is derived from the root word –
‘ ËUcÉç kÉÉiÉÑ and srÉÑOèû mÉëirÉrÉ’
- it means Mala Bhedana.
The word ‘Virechana’ is formed by the root Rici Dhatu, Vi – Upasarga with
‘Nich’ and ‘Lyut’ Pratyayas giving meaning ‘Visheshena Rechayateeti’.
The root ‘Rich’ is also very important to understand the systemic action of
Virechana. According to Charaka, the Virechana drugs first get digested in
Amashaya, then reaches to Hridaya, Dhamani, macro and micro channels (srotases) of
the body and reach the site where Doshas are accumulated.26
Nirukti:
The act of expelling vitiated doshas (malas) through Adhobhaga is known as
Virechana.27
. Here the meaning of Adhobhaga is ‘Guda’ commented by Chakrapani28
.
ÌuÉUåMüÉå qÉÑZÉmÉÏiÉÇ aÉÑSqÉÉaÉëåhÉÉliÉÈ ÎxjÉiÉxiÉ SÉåwÉxrÉ ÌlÉxxÉÉUhÉÇ ÌmÉ¨ÉxrÉ mÉUqÉÉãwÉkÉqÉç||
Virechana is the procedure in which the orally administered drug acts on
internally vitiated Doshas, specifically on Pitta and expels them out through anal
route.
iÉ§É SÉåwÉWûUhÉÇ AkÉÉåpÉÉaÉÇ ÌuÉUåcÉlÉ xÉÇ¥ÉMüqÉç |

45.
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 28
In the context of Jwara Chikitsa it has been mentioned that Sramsana
eliminates the Pitta and Kapha situated in Pakwashaya 67
.
c) Bhedana 68
:The drug which disintegrates the ‘Abaddha’ (unformed) or ‘Baddha’
(formed) or ‘Pindita’ (dried fecal mass) forms of Malas by facilitating penetration into
it and then evacuating through the lower gut, is known as Bhedana. eg. Katuki.
Bhedana is a process in which Shareera Mala Nirharana is brought about 69
.
Charaka has described a group named as ‘Bhedaneeya’. This includes Shyama
(Trivrit), Arka, Urubuka (Eranda), Agnimukhi (Kalikari), Chitra (Danti), Chitraka,
Chirabilva, Shankhini, Sakuladani (Katuki) and Swarnaksiri 70
.
c) Rechana 71
: The drug which eliminates digested (Pakwam) and undigested
(Apakwam) Malas or Doshas by making them watery through the lower gut is
known as ‘Rechana’ eg: Trivrit.
The ‘Rechana’ and ‘Virechana’ words seem to be similar, but the Virechana
represents the complete therapy which includes Purvakarma, Pradhana Karma and
Samsarjana Krama; while the Rechana is the action of the drugs used in Virechana.
There are certain drugs which help in enhancing the action of Virechana Dravyas is
known as Virechanopaga. The drugs described are Draksha, Gambari, Parushaka,
Abhaya, Amalaka, Vibhitaka, Kuvala Badara, Karkandhu, and Pilu72
C. Virechana drugs according to mode of action:
According to the degree of potency of the drugs, the Virechana may be
classified into the following categories.
a) Mridu Virechana73
–
The drugs which are Mridu in Veerya or when combined with opposite Veerya
or given in low dosage, given to the Ruksha patient and causes less purgation is

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known as Mridu Virechana. Those drugs are specifically indicated in weak patients
having mild natured diseases. These drugs may also be given to the patients who have
been Shodhita previously or having Alpa Dosha or whose Koshta is unknown.
Charaka is of the view that the physician should not hesitate to use Mridu Virechana
drugs in weak patients having more Doshas because even repeated elimination of
Doshas in small quantity may cure the disease74
The patient who have not taken Virechana drugs in past and whose Koshta is
unknown in such persons Sushruta recommends the use of Mridu Virechana drugs in
the beginning and after knowing the Koshta required drug may be prescribed 75
Sharangdhara recommends the use of Mridu Virechana drugs in Mridu Koshta
(eg. Draksha, Milk, Caster oil, Warm water etc.) 76
Drugs effective in Mridu Koshta
are Guda, Ikshu Rasa, Mastu, Ullodita Dadhi, Payas, Kshira, Sarpi, Kashamari,
Triphala, Pilu and Taruna Madya . 77
b) Madhya Virechana :
The drugs which are moderate in qualities are known as Madhya Virechana
drugs.
The drugs are specifically indicated in the patients having Madhya Roga (disease
with moderate symptoms). The administration of these drugs in Balava rogi is useless
because, they are unable to eliminate Dosha completely 78
. Sharangdhara recommends
the use of Madhyama Virechana in Madhyama Koshta. eg. Trivrit, Katuki and
Aragvadha79
c)Teekshna Virechana :
The drugs, which cause severe motions (Mahavega) and eliminates the Doshas
in large quantity by quick (Kshipra) and gentle (Sukha) purgation without causing
either much depression (Glani), is known as Teekshna Virechana.

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According to Charaka, the drug which has been kept away from water, heat
and organisms, cultivated in proper Desha and Kala and which has been given
Bhavana with the drugs of same Veerya acquires the Teekshna properties. This type
of drugs having all the required properties, when given in prescribed dosage to the
patient who has been well Snehita and Swedita, then it causes Teekshna Virechana 80
.
Sharangdhara recommends use of Teekshna Virechana drugs in Krura Koshta
persons.
Charaka recommends the use of these drugs in the strong (Balavan) patients
presenting all the symptoms of the diseases i.e. Teekshna Vyadhi81
. It has been further
mentioned that the use of these drugs should be avoided in Durbala (weak), Shodhita,
and patient having Alpa Dosha and whose Koshta is unknown, otherwise it may cause
untoward effects of these patients. Sushruta is of the view that Teekshna drugs given
in Mridu Koshta having Deeptagni, passes out quickly without eliminating Doshas
properly82
, Snuhi Kshira is considered as the best amongst these drugs83
. More over
Sharangdhara recommend the other drugs like Hemakshiri, Danti, etc. explained in
Krura Koshta may also be included in this group.
D. Classification based on guna of drug:
In many places in Ayurveda, the uses of Sneha Virechana and Ruksha
Virechana have been recommended.
The drug used in the form of oil or the preparation containing Sneha is known
as Sneha Virechana, eg: Eranda Taila. Vagbhata recommends the use of Sneha
Virechana in all patients except Snigdha patients 84
. The use of Sneha Virechana in the
patients who have been given higher dosage of Sneha is contraindicated because, due
to this, the moving Doshas may again adhere in the Srotas85
. Sneha Virechana should
be administered in Sama-Shitoshma Kala 86
.

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2) Snehapana :
Snehapana procedure is to be followed after observing Nirama Lakshanas. The
required Sneha should be administered early in the morning at Suryodayakala after
observing Jeerna Ahara Lakshanas of the previous meal and when the patient is empty
stomach. The duration of Sneha Pana should be 3 to 7 days98, 99
.
Regimen after Snehapana:
• Use of Hot water,
• Observing Brahmacharya,
• Avoid Diwa swapa,
• Should not suppress the natural urges like defecation, urination, flatus,thirst
etc,
• Should not expose to vata, atapa.
• Should take anabhishyandhi, liquid, hot diet mixed with slight unctuous
substance100
.
Generally the dose of Snehapana is started from Hrisiyasi matra and
gradually increased up to Uttama matra i.e. dose of Sneha which is digested in 24
hours.
After proper Snehana, on the three gap days, Sarvanga Abhyanga and Svedana
are done daily.
Charaka mentions that by Vriddhi (increasing), Vishyandana (dissolving),
Paka (digesting), Srotomukha Vishodhana (clearing the orifice of srotas) and Vata
Nirodha (regarding the movement of Vata), the morbid material may be brought back
from Shakha to Koshta101
. Here, Sneha acts in every aspect of above processes.
In sneha satmya patient, first rukshana is carried out after that virechana is
planned.Patients who have ruksha shareera,krura koshta,vata pradhana, who is

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habituated of doing exercise daily, having good appetite should be given sneha basti
prior to virechana, if this is not done,then virechana aoushadi gets digested instead of
causing virechana102
.
3) Abhyanga :
According to concept of Ayurveda, the Sneha absorbed in the body through
the minute hair follicles of skin and its effect is enhanced by Bhrajaka Pitta103
4) Swedana:
‘Dosha Vilayana’ takes place through the Swedana. It dilates all the channels
in the body. During the Swedana procedure the blood volume will be raised
(increased). All the bodily secretions will be increased due to stimulation of various
glands. According to Vagbhata, by the action of Snehana and Swedana, the morbid
Doshas are liquefied, dissolved and are brought to koshta104
.
Dalhana also mentions that the Dosha which are lodged in Shakha are made to
move towards to Koshta by Snehana and Swedana. Vagbhata mentions that the waste
products are removed from the shakhas by these two procedures of Snehana and
Swedana in the same fashion as dirt of cloth is removed by soap and water105
.
During the procedure of Abhyanga and Swedana, Snigdha, Drava, Ushna
bhojana, Mamsarasa, Odana, Amla rasa Phala is recommended106
.
Before pradhana karma the diet should be such that, it does not increase
‘Kapha’ otherwise Vamana may occur107
.
‘Manda Kapha’ term is used for the state of Kapha, which is desired for the
proper Virechana.
The dose of Virechana Yoga should be decided according to Vyadhibala,
Aturabala and Agnibala108
. If the dose given more than Vyadhibala, may cause
another Vyadhi. If it is more than Agnibala it may cause Ajeerna, Vishtambha, and if

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it is more than Aturabala then it may cause Atipravrtti or Apravrtti. So, the dose
should be in Sama Pramana only.
PRADHANA KARMA:
Pradhana Karma includes administration of Virechana yoga, observations for
Aushadha Jirnata and observations of Shuddhi Lakshanas and management of Vyapat
if occurs.
1. Administration of Virechana yoga:
Before administering the Virechana yoga, the physician must be confirmed
regarding the following.
a. The diet taken by the patient on the previous day must be digested.
b. Patient is in mentally balanced state, i.e., without any passions like angry, fear
etc.
c. It should be kept in mind that whether the patient got sound sleep on the
previous night or not. Because at the time of drug administration patient must
not be drowsy/ sleepy.
After confirming the above points, patient has to offer oblations and worships
before taking the drug. Then the drug should be given to the patient to suit the kosta
after the Shleshma kala. The time is so adjusted that the Virechana should be started
during Pitta kala. The Pitta kala falls between 10 am to 2 pm. quickly acting drugs
must be given 1-2 hours prior to Pitta kala; where as a drug with slow onset of action
should be administered much earlier.
If Virechana does not occur then hot water should be given and Swedana
should be done on the abdomen by the heat produced with friction of both palms
‘Pani Taptai Cha. Jatharangani, Swedayet109

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The Vaidya or physician must observe the signs and symptoms of
Jeernoushadha, Ajeernoushadha, Hritha Dosha, Vyapat, etc.
OBSERVATIONS:
a) Aushadha Jeerna Lakshana:
The following signs and symptoms of Virechana are to be observed –
Vatanulomana, Swasthya, Khsudha, Trishna, Urjamanaswita, Indriya Laghuta and
Udgara Shuddhi110
.
b) Ajeerna Aushadha Lakshana:
If the drug is not digested it will produce some painful symptoms such as
Klama, Daha, Angasadam, Bhrama, Murcha, Shiroruja and extreme weakness.
In this case the Virechana drug should not be repeated immediately, as the
drug may produce severe purgation. In some cases if the drug is digested but proper
elimination of doshas didn’t occurred, then next day again Virechana drug should be
given.
c). Hritadosha Lakshana:
The Virechana is considered as Kaphanta and Hritadosha, when Vata, Pitta
and Kapha come out in succession. Gatra Daurbalya and Laghuta are the associated
symptoms. If Virechana persists even after manifestation of Hritadosha lakshanas,
then vamana should be given.111
If Aushadhi Jeerna Lakshanas are manifested, but Hritadosha Lakshanas are
not found, then Virechana Yoga should be given next day. Even then Virechana does
not occur then Snehana and Swedana should be done again and thereafter Virechana
drug should be administered after 10 days112
.

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c) Shuddhi Lakshana113-117
:
Four types of Shuddhi viz. Laingiki, Antiki, Vegiki and Maniki should be
observed according to Chakrapani, but the importance should be given to Laingiki
Shuddhi.
Table no 18: Criteria for Antiki, Vegiki and Maniki Shuddhi of Virechana
Karma
Shuddhi Pravara Madhyama Avara
Vegiki 30 Vegas 20 Vegas 10 Vegas
Maniki 4 Prastha 3 Prastha 2 Prastha
Antiki Kaphanta Kaphanta Kaphanta
The number of Vegas should be counted after leaving the first 2-3 Vegas, as it
contain only fecal matter. Then it should be counted till the Kapha comes out.
Laingiki Shuddhi, Lakshanas are given in tables. Thereafter the Ayoga and
Atiyoga symptoms mentioned in the texts have been presented in the tabular form. In
the last the various types of complications which may occur during Virechana are
depicted.
Table no 19: Samyak Yoga Lakshanas of Virechana Karma
Lakshanas C.S S.S Va
Sroto Vishuddhi + - -
Indriya Prasadana + + -

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Mamsa Dhavana vat udaka srava - - +
Medokhandavat Srava - - +
Trishna - - +
Bhrama - - +
Netra praveshanam - - +
Raktakshayaja Vikara + - -
PASCHAT KARMA118-121
:
Regimens to be adopted after Virechana karma till the patient able to
take normal diet are termed as Paschat karma. As the Virechana karma eliminates
dushita Pitta dosha, the patient shouldn’t be allowed to take heavy diet, because there
is derangement in power of jatharagni. In this condition if heavy diet is given, it will
only suppress only the digestion power further and causes the vitiation of Agni. So to
prevent such condition, samsarjana karma is adopted.
a) Samsarjana Krama :
As said above, to restore the strength of agni.The patient has to be given the
following varieties of diets, from the same day evening or from the next day
morning122
.
After Samshodhana Karma, Agnimandya occurs because the Doshas reach the
Amashaya (Jejjata), so Peyadi Krama is recommended to increase the Agni gradually
up to the normal level.
According to Chakrapani the elimination therapy diminishes the doshas as
well as Dhatus, that’s why patient need immediate Dhatu Vardhaka Ahara in terms
of Peyadi Samsarjana karma.

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that incase of Ksheena Kapha, Peya should be given. Mamsarasa should be given to
Vata pradhana patients having Deeptagni. If Kapha dominance is there according to
Dosha and Prakriti, then Kulatha Yusha should be given. The Peyadi Krama ends on
7th
day of Pradhana Shuddhi patient.Acharya Sushrutha has opined samsarjana krama
in respect to bala of the patient127
b) Tarpana :
In case of ayoga of Virechana (insufficient elimination of vitiated doshas)
associated with predominance of Kapha, Pitta, if the doshas still retained in the body
and if the patient is having habit of taking alcohol, he shouldn’t be given Peyadi
Samsarjana Krama. Instead he must be given Tarpana i.e., thin or thick soup prepared
with Deepana and Pachana drugs like, Pippali, Dadima etc.
In Tarpana, Swaccha Tarpana in place of Peya and Ghana Tarpana in place of
Vilepi should be given, according to Chakrapani128
. Jejjata mentions Mudga, Yusha
and Mamsarasa in place of Peya. Arunadatta recommends Laja Saktu,
Jirnashalyodana and Mamsarasa for 3 Annakalas.
Rasa samsarjana krama:
Acharya Charaka and Sushrutha has given a special sequence of rasa intake in
samsarjana krama to be followed to avoid the chances of vitiation of doshas129
.
Acharya Charaka has advised to take madhura, amla and hridhya ,snigdha
ahara to pacify vata.Amla lavana to increase agni,Madhura and tikta rasa to pacify
pitta dosha,kashaya and katu rasa to pacify kapha dosha130
.
Acharya Sushrutha opined that rasa should be started with Madhura and Tiktha
to increase the agni and to pacify vata pitta. Then snigda,amla,lavana and katu rasa to
reduce vata,kapha dosha followed by madhura tikta rasa to pacify vata pitta

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MODE OF ACTION OF VIRECHANA:
ÌuÉUåcÉlÉÇ iÉÑ xÉuÉÉåïmÉ¢üqÉåprÉ: ÌmÉ¨Éå mÉëkÉÉlÉiÉqÉÇ qÉlrÉliÉå ÍpÉwÉeÉ:,
iÉk±ÉÌSiÉ LuÉÉqÉÉzÉrÉqÉlÉÑmÉëÌuÉzrÉ MåüuÉsÉÇ uÉæMüÉËUMÇü ÌmÉ¨ÉqÉÔsÉqÉmÉMüwÉïÌiÉ,|136
Action of Virechana Karma can be understood in the following two ways.
1. Systemic – By which it brings down the morbid Doshas, particularly Pitta from the
periphery to Amashaya or Pakwashaya.
2. Local evacuant – This is concerned with the evacuation of these doshas in the
form of mala from the gut by Adhobhaghahara property.
Both the action and related factors are being described here in detail -
a) Virechana yoga gets absorbed and due to Veerya, it reaches to the Hridaya,
then the Dhamanis and thereafter it reaches to Sthula and Anu Srotas i.e. macro and
micro channels of the body.
b) The Vyavayi Guna, drug is responsible for quick absorption.
c) The Vikashi Guna causes softening and loosening of the bond by Dhatu
(Shaithilya Karma).
d) Due to Ushna Guna, the Dosha Sanghata (compactness) is disintegrated
(Vishyandana).
e) Action of Teekshna Guna is to break the Mala and Dosha in micro form.
According to Dalhana it is responsible for quick transmission (Dosha Sravana
Karatwa).
f) Due to Sookshma Guna by reaching in micro channels, disintegrates
androgenic toxins which are then excreted through micro channels (Anupravana
Bhava).

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g) Mainly due to Prabhava, Prithwi-Jala constitution and presence of Sara
Guna
Virechana occurs. This is the evacuant action.
From the above description, a hypothesis can be postulated that, due to the
Veerya of the Virechana drugs softening, disintegration, liquification occurs which
helps in elimination of morbid factors in the body.
PURGATIVES
Drugs that promote evacuation of bowels.
Purgation: - (Pur-ga shun), Latin word, - An agent that will stimulate the production
of bowel movements.
Purge- (purj), [Latin word-Purgare, to cleanse], A drug that causes evacuation of the
bowels.
Purgative – [Lat-Purgatius] 1) Cleansing 2) An agent that will stimulate the
production of bowel movements.
P-Cholagogue – P. - that stimulste the flow of bile, producing green stools.
P-Drastic – P- that produces violent bowel movements.
P-Saline – P- that produces copious watery discharges.
SYNONYMS:
Aperients, Cathartics , Laxatives, Purgatives.
Apereient- (a-pere-ent), [Lat, aperiens,opening].
A very mild laxatives.
Cathartic- (ka-thartic), [Greek word-kathartikosis,purging]
An active purgative, producing bowel movements.

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Laxative-Lax (laks), [Lat-laxus,slack]
1. Without tension. 2. Loose & not easily controlled, said of bowel
movements.
Laxation (lak-sa-shun), [Lat-laxare, to loosen], Bowel movement
Laxative (lak-sa-tiv), [Lat-laxare, to loosen], A food or chemical substances that acts
loosen the bowels (i.e. fecilitate passages of bowels contents at time of defecation).
Therefore, to prevent or treat constipation.
Laxator(lak-sa-tor),[Lat-laxare, to loosen], that which has a relaxing effect.
A distinction is sometimes made according to the intensity of action.
a). Laxative or Aperient – milder action, elimination of soft but formed stools.
b). Purgative or Cathartic – stronger action resulting in more fluid evacuation.
Many drugs in low doses act as laxative and in larger doses as
purgatives.
CATHARTICS - MODERN VIEW137, 138
The terms laxatives, cathartics, purgatives, aperients and evacuants often are used
interchangeably. However, there is distinction between Laxation and catharsis.
Laxation means – the evacuation of formed fecal material from the rectum, whereas
Catharsis means – the evacuation of unformed, usually watery fecal material from the
entire colon. Most of the commonly used agents promote Laxation but some actually
are cathartics which, at low doses, are used as laxatives.
There are three types of intestinal movements viz,
Pendular movements – are due to annular contraction of longitudinal muscles.

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Segmental movement – due to contraction of circular muscle and peristaltic
movement. First two are mainly responsible for mixing of food, while peristalsis also
helps in propulsion. Normally the food leaves the stomach in about half to two and
half hours and its residue reaches the caecum by about 5 to 6 hours. It takes
approximately 18 to 24 hours before the process of evacuation starts and the total time
necessary for complete clearance of the ingested material is approximately 5 to 6
days. The G.I tract is innervated by both Sympathetic or Adrenergic nerves and
Parasympathetic or Cholinergic nerves. Usually stimulation of adrenergic nerves
produces an inhibitory effect on the movements of the intestine, resulting in the
relaxation of the gut and closure of the Sphincters. Where as if cholinergic nerves and
Vagus are stimulated, the tone and peristaltic movements of the intestines will be
increased. Emotions are known to play an important role in the physiology of
gastrointestinal secretions and movements.
Normally, most of the ingested water and fluids secreted by various
gastrointestinal glands are reabsorbed in the small intestine and caecum. And only
100 ml of fluid is excreted with the fecal matter. Hence a cathartic which mainly act
on small intestine is likely to produce considerable loss of fluids, electrolytes and
nutrients from the gut. On the other hand Cathartic which act mainly on colon
produce relatively less fluid loss and don’t interfere with the absorption of food.
The rate of intestinal passage of food depends on the nature of the diet and its
fluidity. Diminished intake of both water and indigestible residue can lead to
constipation.

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RUTU
Vedic Period:
Yajurveda: There is description of six rutus and their respective months1
.
• Madhu Madhav –Vasant rutu
• Shukra Shuchi-Greeshma rutu
• Nabha nabhasya- Varsha
• Isha Urja –Sharad
• Saha Sahasya-Hemant
• Tapa Tapasya-Shishira
Jaiminiya Brahman:
As per the agnishomiya siddhant, there are three major rutus, viz., Grishma
Varsha Hemant whereas the three rest are depends upon them.2
Shathapatha Brahman:
There are six rutus in one year. Here the whole year is considered as yagna
and six rutus are part of it.3
Table No.31:Table showing correlation of rutu with parts of yagna
Vasant Samidha
Greeshma Agni
Varsha Ida
Sharad Barhi
Hemant Swaha

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Table No.34:Table Showing Characteristic of all rutus in Single day.
Rutu Characteristic
Vasant Early Morning
Greeshma Mid Day
Varsha Afternoon
Hemant At the time of End of day
Sharad Evening
In Sahitya
In Panini Ashthadhyayi the word sharad has been used to denote Rog and
Aatap.
Sharad shabda thay pratyaya (4/2/13)
It will give two forms, shardiko rogah, shardo rogah6
Shriharsha
There is elaboration of administration of nimba patra in vasant rutu.7
In samhita Period
Charaka samhita
The year is divided into six parts according to seasons. The northward
movement of the sun and its act of dehydration bring about three seasons beginning

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from late winter to summer.The southward movement of sun and its act of hydration
give rise to other three seasons beginning with the rainy to early winter.8
Table No.35:Table showing season and their respective months.
Season Months Hindu calendar Months English
calendar
Shishir(late winter) Magha-falguna Jan-Mar
Vasant(spring) Chaitra-vaishakha Mar-May
Greeshma(Summer) Jeshtha-aashadha May-Jul
Varsha(rainy) Shravan-bhadrapada Jul-Sept
Sharad(autumn) Ashwin-kartik Sept-Nov
Hemant(early winter) Margshirsha-pousha Nov-Jan
In the period of visarg, winds are not very dry as they are during period of
Aadan.The period of visarg predominantly shares the qualities of moon and during
this period the moon with the unstrained cooling property continuosly delight the
world with its soothing rays. On the other hand the period of Aadan is dominated by
qualities of Agni.9
During the period of Aadan not only sun with its rays but also wind with its
sharp velocity and dryness absorb the moisture from the earth. Winds progressively
brings about dryness in the atmosphere during the three seasons of this period,viz.,
shishir,vasant,grishma, which enhances the bitter, astringent, and pungent tastes
respectively.All having drying effects and as a result human being also become
weak.10

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During the varsha, sharad, and hemant rutus the sun moves towards the south
and its power is slackened by various factors viz., time,course,storm and rain but the
moon is not affected.The earth is relieved of its heat by the rain water.Sour, salty,
sweet tastes which causes unctuousness in the body grows during the varsha sharad
hemant respectively.11
As a result of all these , human beings also progressively grow
in strength. Strength during different seasons12
Table No.36:Table showing strength during different seasons
Season Strength
Greeshma, Varsha Alpa
Vasant, Sharad Madhyama
Hemant, Shishir Uttama
Sushrut Samhita
Magha etc. Are the twelve months. Two months make one rutu, which are
six in number such as shishir, vasant greeshma, varsha, sharad, hemant13
.
Table No.37: Table showing season and their respective months.
Months Rutu
Tapa, tapasya Shishir
Madhu,madhava Vasant
Shuchi,shukra Greeshma
Nabha,nabhasya Varsha
Isha,urja Sharad
Saha,sahasya Hemant

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Six rutus are divided on the basis of predominance of effect of the sun and moon
and characterized by cold, heat, and rain respectively. Become divided into two ayan
viz., dakshin and uttar.Varsha,sharad and hemant form dakshina ayan.shishir vasant
and greeshma form uttarayan.14
During forenoon the features of vasant rutu should be expected in the body,
during mid day those of greeshma,during afternoon those of pravrut during evening
those of varsha during midnight those of sharad and during morning those of
hemant.15
In this manner the qualities of the seasons such as cold heat and rain should be
understood as happening during every day, as happening in year.
Astang samgraha: Kala is divided into the following twelve parts.16
Table No.38:Table Showing twelvefold division of kala
Matra Time required for blinking the eyelid
Kashtha 15 matra
Kala 30 kashtha
Nadika 10 kashtha+20 kala
Muhurta 2 nadika
Yama 3 hours
Ahoratra 8 yama
Paksha 15 ahoratra
Masa 2 paksha
Rutu 2 masa

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Ayana 3 rutu
Varsha 2 ayana
He followed sushruta to describe the effect of ayana and strength of human being in
different rutus.
Astang Hradaya: With every two months commencing with magha are the six rutus
shishir, vasant, greeshma, varsha, sharad, hemant successively. Shishir, vasant,
greeshma form the uttarayan also known as aadan kala because the sun takes away the
strength of the people daily. Varsha, sharad, hemant form the dakshinayan also known
as visarga kala because the moon gives the strength to the people daily.17
Sharangdhara: Movement of the sun from one stellar constellation to the other makes
for the six rutus 18
.
Table No.39:Table showing the rutu and their respective constellation.
Rutu Constellation
Greeshma Mesha, vrishabha
Pravrut Mithuna, karka
Varsha Simha, kanya
Sharad Tula, vrischik
Hemant Dhanu,grahi
Vasant Kumbha,meen
Yogaratnakar: Magha etc. Are the twelve months.Two monts make one rutu, which
are six in number such as shishir, vasant greeshma, varsha, sharad, hemant.19

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MEASURES TO BE ADOPTED AS PER RUTUS:
Vedic period:
Gopatha Brahman:The diseases are going to manifest during rutusandhi,hence yagnya
has to be perform during this period.20
Jaiminiya Brahman:During sandhikala there is elaboration of ashwini ukth.21
Shathapatha Brahman:the Brahman has to perform yagnya during vasant
rutu,kshatriya during greeshma,and vaishya during varsha rutu.22
Aapastambha kshoutrasutra: The yagnya has been told as per the rutus,23
• Vasant-vaishwadev yagnya
• Pravrut-varunpraghas yagnya
• Sharad-shakmedha yagnya.
Charak samhita: Having the administration of purification therapies in view ,seasons
are thus divided into six.There are three rutus pravrut sharad and vasant which are of
moderate nature.24
Purificatory therapies viz., vaman etc.,should be administered only in seasons of
moderate nature.In other seasons having extreme cold ,heat, or rain such therapies
should not be administered .If needed administered with utmost care.25
The disease in its early stage appears to be insignificant but it grows and
grows thereafter and after gaining a strong hold in the body it takes away the strength
and life of fool.26

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In case of a poor man in the event of emergency necessitating the
administration of the purification therapy should take the prescribed drugs available
without caring for collecting all the rare medicaments in advance.All the prescribed
medicaments are not available to all human beings.At the same time diseases can
attack even poor.So in these circumstances whatever drugs, cloths, diets are easily
available should be used by patients according to their capacity.27
The person who undergo purificatory measures at regular interval will live free of
diseases. Doshas accumulated in hemant be eliminated in vasant,those accumulated
in greeshma be eliminated in abhrakal and those accumulated in varsha be eliminated
in sharad.28
Sushrut samhita: In ayurveda varsha, sharad, hemant, vasant, greeshma, and pravrut
are the six rutus, which are the causes for upachaya,prakopa and upashama of doshas.
These happens in every two month commencing from bhadrapada.29
Table No.40:Table showing the rutus with respective months.
Month Season
Bhadrapada,ashwayuja Varsha
Kartik,margasheersha Sharad
Pousha,magha Hemant
Falgun,chaitra Vasant
Vaishakha,jeshtha Greeshma
Aashadha,shravan Pravrut

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The accumulated pitta undergoes prakopa in sharad rutu,in which the sky
has scattered clouds,sun’s rays dries up the slush(moisture of the earth) and produces
diseases caused by pitta.30
Doshas which have accumulated in varsha hemant and greeshma should be
eliminated out during sharad vasant and pravrut.31
Astang samgraha: Just as slit develops surely ,in course of time, even in pure water
kept undisturbed in a earthen pot ,so also dirt accumulates inside the body hence it
should be removed from the body at appropriate times.32
The doshas undergoing increase slowly in the body of such persons, who
are negligent of taking purificatory measures, produce many diseases which might
even deafly treatment.
Doshas which have been mitigated by fasting and use of digestive drugs are likely to
increase ones again but those conquered by purificatory measures will never increase
again.33
In varsha pitta undergo only chaya because the food substances that are
used then, posses more moisture and become sour at the end of digestion and similar
condition exists inside the body also. It does not undergo prakopa because of the cold
of season.34
The ideal time for administration of therapies like emesis and purgation is
the day time of the ordinary seasons; whereas the day time of other seasons are
unsuitable because of the risk of inadequate or excessive bouts. Ordinary seasons are
ideal because of mild degrees of cold heat and rain during these seasons and so are
easy and harmless. Opposite will be condition in other seasons.35
The rules and

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regimen so far described for each season is meant only for persons who are healthy;
for others(sick person) separate regimen will be described later while elaborating
diseases.36
Astang hradaya: All our efforts should be made to clear out the malas(doshas and
waste products) at appropriate time ,their accumulation may become life
threating.Hence the doshas should be removed out of the body as per their shodhana
kala.37
The doshas which are get aggravated followed by chaya those should be
removed out by purificatory measures and which are aggravated without chaya ,in
such cases shaman should be adopted.38
The accumulation of doshas arising from cold season should be expelled
out during vasant, that arising from grishma should be expelled during abhrakala ,that
arising from varsha be expelled during ghanatyaya expeditiously and effectively.By
this people will not become victims of diseases born by the effect of the seasons.39
Vayu and other two doshas which have undergone chaya in greeshma
varsha and hemant should be removed out in the sadharan months.40
BHEL: One should take honey in rainy season, ghee in sharad, varuni mixed with
gandak in shishira, grape juice in vasant and milk in greeshma rutu.
Whenever earth becomes satisfied with water and gets endowed with flowers,in tha
season purificatory measures should be adopted.When sun starts travelling mid way in
the sky and stretches upward grass and other element then when spring arrives then
emesis to be given.Purificatory measures should be adopted in the season in which
cool and hot nature present moderately.41

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In sharad rutu one should undergo siravyadha.
SHARAD RUTU CHARYA:
Charaka: In this season sweet, light, cold and bitter foods and drinks which have
potentialities to alleviate pitta are to be taken in proper quantity when there is good
appetite.The meat of common quail,grey partridge, antelope, sheep, wapiti, rabbit,
rice, barley, and wheat are prescribed during this season.One should avoid taking sun
bath ,vasa(fat), oil and meat of aquatic and marshy animals,alkaline salt preparations
and curd in food.One should not sleep during day time and should not expose himself
to frost and facing wind.Use of garlands made of autumnal flowers and clean apparel
and also the rays of the moon are exceedingly beneficial in this season.50
Sushruta: In autumn season one should be careful to take substances with astringent
sweet and bitter tastes,milk, sugarcane products, honey, shali, green gram etc. And
meat of wild animals.He should enjoy moon light wearing white garlands in the early
night the dress should be light and fine.All water is beneficial because of being clear.
One may swim in tanks decorated with lotus and lily and apply paste of sandal
One should avoid irritant, sour , hot, alkaline items in food ,day sleep, sun rays, night
awaking.51
Astang samgraha:The foods and drinks should be cold easy to digest, less in quantity
with sweet bitter and astringent tastes, rice, wheat, barley, green gram, sugar, honey,
patola, aamalaka, draksha and meat of animals of desert like regions are good for
those who have very good hunger. Day time should be spent in sailing in lakes which
are full of swans, rows of humming bees, and blossomed lotus flowers, wearing light

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and clean dress, garlands, anointing the body with the paste of ushira which is
coolant, nights should be spent on a terrace having good moonlight.
Over satiation, curds, sunlight, alkaline substances, muscle fat ,oils, eastern breeze,
strong alcoholic drinks, sleeping during day time should be avoided.52
ASTANGA HRADAYA: When hungry the person should take foods which are of
bitter sweet and astringent tastes and easily digestable such as Sali, mudga, sita dhatri
patola, madhu and meat of animals of desert like lands.Evening should be spent on the
terraces of houses by anointing the body with the paste of chandana, ushira, and
karpura wearing garlands of pearls enjoying the moonlight.Exposure of mist,
indulgence in alkaline substances, satiation with hearty meal, use of curd ,oil, muscle
fat, exposure to sun light, strong liquors, sleeping at day time and the eastern breeze
should be avoided.53
BHEL
In autumnal season cooling measures should be adopted to counteract the
aggrevated pitta such as bathing, anointing.Person should fan himself with the large
stalk of Palmyra leaves roam around the lakes.He should drink laja saktu along with
water containing sugar or honey.Person should eat old rice specially the one that
matures in sixty days along with a soup of mudga.Person should consume sweet taste
and the juice of vidari, ikshu, and draksha.Person should drink ghee.54
HARITA:Person should consume the boiled milk, sugar candy, receive the moon light
in early night.Person should adopt the cooling measures,roaming around
lakes.anointing the body with cooling drugs such as chandana.55

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YOGARATNAKAR: Substances having sweet, astringent, bitter tastes ,light to
digest, meat of desert animals, godhuma, yava, mudga, shali should be used. For
drinking milk, sugarcane juice are useful.exposure to moonlight by wearing clean
light cloths by anointing the body with chandana.
Person should avoid the curd, exercise, sour, pungent substances, day sleep, exposure
to sun light.56
GADANIGRAHA: Person should consume the substances having cooling properties,
for drinking usage of milk, grape juice, sugarcane juice.
Person should avoid the irritant, alkaline, hot substances, day sleep, oil, heavy
substances.57
HAMSODAK: The water is exposed to the heat of the sun during the day time and to
the cooling rays of moon during night and is detoxicated by star canopus(agastya) this
is known as hamsodaka and is a beneficial as nectar for the purpose of bathing and
drinking.58
Season59
A season is a division of the year, marked by changes in weather, ecology, and hours
of daylight.Seasons result from the yearly revolution of the Earth around the Sun and
the tilt of the Earth's axis relative to the plane of revolution. In temperate and polar
regions, the seasons are marked by changes in the intensity of sunlight that reaches the
Earth's surface, variations of which may cause animals to go into hibernation or to
migrate, and plants to be dormant.

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In temperate and subpolar regions generally four calendar-based seasons are
recognized: spring (adj. vernal), summer (adj. estival), autumn (adj. autumnal), and
winter (adj. hibernal). However, ecologists are increasingly using a six-season model
for temperate climate regions that includes pre-spring (adj. prevernal) and late
summer (adj. seritonal) as distinct seasons along with the traditional four.
Chinese seasons are traditionally based on 24 periods known as solar terms, and begin
at the midpoint of solstices and equinoxes.
Causes and effects:
Illumination of the earth during various seasons
This is a diagram of the seasons, regardless of the time of day (i.e. the Earth's rotation
on its axis), the North Pole will be dark, and the South Pole will be illuminated. In
addition to the density of incident light, the dissipation of light in the atmosphere is
greater when it falls at a shallow angle.
Effect of sun angle on climate: The seasons result from the Earth's axis being tilted to its
orbital plane; it deviates by an angle of approximately 23.5 degrees. Thus, at any given time
during summer or winter, one part of the planet is more directly exposed to the rays of the
Sun ( Fig. 1). This exposure alternates as the Earth revolves in its orbit. Therefore, at any

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given time, regardless of season, the northern and southern hemispheres experience opposite
seasons.
The effect of axis tilt is observable from the change in day length, and altitude of the
Sun at noon (the culmination of the Sun), during a year.
Seasonal weather differences between hemispheres are further caused by the elliptical
orbit of Earth. Earth reaches perihelion (the point in its orbit closest to the Sun) in
January, and it reaches aphelion (farthest point from the Sun) in July. Even though the
effect this has on Earth's seasons is minor, it does noticeably soften the northern
hemisphere's winters and summers. In the southern hemisphere, the opposite effect is
observed.
Seasonal weather fluctuations (changes) also depend on factors such as proximity to
oceans or other large bodies of water.In the temperate and polar regions, seasons are
marked by changes in the amount of sunlight, which in turn often causes cycles of
dormancy in plants and hibernation in animals. These effects vary with latitude and
with proximity to bodies of water. For example, the South Pole is in the middle of the
continent of Antarctica and therefore a considerable distance from the moderating
influence of the southern oceans. The North Pole is in the Arctic Ocean, and thus its
temperature extremes are buffered by the water. The result is that the South Pole is
consistently colder during the southern winter than the North Pole during the northern
winter.
The cycle of seasons in the polar and temperate zones of one hemisphere is opposite
to that in the other. When it is summer in the Northern Hemisphere, it is winter in the
Southern Hemisphere, and vice versa.

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In the tropics, there is no noticeable change in the amount of sunlight. However, many
regions (such as the northern Indian Ocean) are subject to monsoon rain and wind
cycles. A study of temperature records over the past 300 years shows that the climatic
seasons, and thus the seasonal year, are governed by the anomalistic year rather than
the tropical year.
In meteorological terms, the summer solstice and winter solstice (or the maximum
and minimum isolation, respectively) do not fall in the middles of summer and winter.
The heights of these seasons occur up to seven weeks later because of seasonal lag.
Seasons, though, are not always defined in meteorological terms.
Compared to axial tilt, other factors contribute little to seasonal temperature changes.
The seasons are not the result of the variation in Earth’s distance to the sun because of
its elliptical orbit. Orbital eccentricity can influence temperatures, but on Earth, this
effect is small and is more than counteracted by other factors; research shows that the
Earth as a whole is actually slightly warmer when farther from the sun. This is
because the northern hemisphere has more land than the southern, and land warms
more readily than sea.http://en.wikipedia.org/wiki/Season ‐ cite_note‐2#cite_note‐2 Mars
however experiences wide temperature variations and violent dust storms every year
at perihelion.[
Meteorological: Meteorological seasons are reckoned by temperature, with summer
being the hottest quarter of the year and winter the coldest quarter of the year. Using
this reckoning, the Roman calendar began the year and the spring season on the first
of March, with each season occupying three months. In 1780 the Societas
Meteorologica Palatina, an early international organization for meteorology, defined

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seasons as groupings of three whole months. Ever since, professional meteorologists
all over the world have used this definition. So, in meteorology for the Northern
hemisphere: spring begins on 1 March, summer on 1 June, autumn on 1 September,
and winter on 1 December.
In Sweden and Finland, meteorologists use a different definition for the seasons,
based on the temperature: spring begins when the daily averaged temperature
permanently rises above 0° C, summer begins when the temperature permanently rises
above +10° C, summer ends when the temperature permanently falls below +10° C
and winter begins when the temperature permanently falls below 0° C. "Permanently"
here means that the daily averaged temperature has remained above or below the limit
for seven consecutive days. This implies two things: first, the seasons do not begin at
fixed dates but must be determined by observation and are known only after the fact;
and second, a new season begins at different dates in different parts of the country.
Astronomical: The following diagram shows the relation between the line of solstice
and the line of apsides of Earth's elliptical orbit. The orbital ellipse (with eccentricity
exaggerated for effect) goes through each of the six Earth images, which are
sequentially the perihelion (periapsis—nearest point to the sun) on anywhere from 2
January to 5 January, the point of March equinox on 20 or 21 March, the point of June
solstice on 20 or 21 June, the aphelion (apoapsis—farthest point from the sun) on
anywhere from 4 July to 7 July, the September equinox on 22 or 23 September, and
the December solstice on 21 or 22 December.

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In astronomical reckoning, the solstices and equinoxes ought to be the middle of the
respective seasons, but, because of thermal lag, regions with a continental climate
often consider these four dates to be the start of the seasons as in the diagram, with the
cross-quarter days considered seasonal midpoints. The length of these seasons is not
uniform because of the elliptical orbit of the earth and its different speeds along that
orbit.
From the March equinox it takes 92.75 days until the June solstice, then 93.65 days
until the September equinox, 89.85 days until the December solstice and finally 88.99
days until the March equinox. In Canada and the United States, the mass media
consider the astronomical seasons "official" over all other reckonings, but no legal
basis exists for this designation.
Because of the differences in the Northern and Southern Hemispheres, it is no longer
considered appropriate to use the northern-seasonal designations for the astronomical
quarter days. The modern convention for them is: March Equinox, June Solstice,
September Equinox and December Solstice. The oceanic climate of the Southern

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Hemisphere produces a shorter temperature lag, so the start of each season is usually
considered to be several weeks before the respective solstice or equinox in this
hemisphere, in other countries with oceanic climates, and in cultures with Celtic roots.
Ecological seasons: Ecologically speaking, a season is a period of the year in which
only certain types of floral and animal events happen (e.g.: flowers bloom—spring;
hedgehogs hibernate—winter). So, if we can observe a change in daily floral/animal
events, the season is changing.
The temperate areas:Six seasons can be distinguished. Mild temperate regions tend
to experience the beginning of the hibernal season up to a month later than cool
temperate areas, while the prevernal and vernal seasons begin up to a month earlier.
For example, prevernal crocus blooms typically appear as early as February in mild
coastal areas of British Columbia, the British Isles, and western and southern Europe.
The actual dates for each season vary by climate region and can shift from one year to
the next. Average dates listed here are for cool temperate climate zones in the
Northern Hemisphere:
• Prevernal (ca.1 March–1 May)
• Vernal (ca.1 May–15 June)
• Estival (ca.15 June–15 August)
• Serotinal (ca.15 August–15 September)
• Autumnal (ca.15 September–1 November)
• Hibernal (ca.1 November–1 March)
Traditional season divisions:Traditional seasons are reckoned by insolation, with
summer being the quarter of the year with the greatest insolation and winter the

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quarter with the least. These seasons begin about four weeks earlier than the
meteorological seasons and 7 weeks earlier than the astronomical seasons.
In traditional reckoning, the seasons begin at the cross-quarter days. The solstices and
equinoxes are the midpoints of these seasons. For example, the days of greatest and
least insolation are considered the "midsummer" and "midwinter" respectively.
So, according to traditional reckoning, winter begins between 5 November and 10
November, spring between 2 February and 7 February, summer between 4 May and
10 May, and autumn between 3 August and 10 August. The middle of each season is
considered Mid-winter, between 20 December and 23 December, Mid-spring,
between 19 March and 22 March, Mid-summer, between 19 June and 23 June, and
Mid-autumn, between 21 September and 24 September.
India:In India, and in the Hindu calendar, there are six seasons or Ritu: Hemant (pre-
winter), Shishir (Winter), Vasanta (Spring), Greeshma (Summer), Varsha (Rainy) and
Sharad (Autumn).

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• Excessive bhaya, krodha, shoka.
Kala:
• Ushnakala,and Sharad rutu, madhyahna, ardharatri, during the digestion
of the food.
Dushta Rakta Lakshana:
The Rakta thus getting vitiated exhibits various features depending on the
predominance of Dosha.12
• The Rakta which is frothy, slightly reddish, black, nonslimy, thin, flowing
quickly and not clotting are the features of the blood vitiated by Vata.
• Neela, peeta, harita, shyava, visragandhi, not liked by ants and flies and
askandhi rae features of rakta vitiated by Pitta.
• Colour similar to gairikodaka, snigdha, sheetala, bahala, picchila, chirasravi
(flowing slowly), mamsapeshiprabha are features of Kapha dusta rakta.
• Raktha exhibits all the above said features resembliing Kanjika and having very
bad smell (durgandhi) are features of tridosha dushta rakta and exhibiting
features of any two doshas is dwidoshaja dusta Rakta.
Raktapradoshaja Vikara: Irrespective of doshic involvement, Dustarakta
produses certain laxanas/vyadhis
Table No.26: Showing Raktaradoshaja Rogas/Laxanas according to
diffrennt authours:

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qÉÉå¤ÉhÉ; ‘mÉÑ’, qÉÉå¤ÉiÉå SÒZÉqÉlÉålÉ CÌiÉ |
The word ‘Mokshana’ is derived from the root ‘Moksh’ means ‘to relieve’ or
‘to let out’13
.
Thus letting out of rakta from the body is Raktamokshana.
Historical review:As far as Ayurveda is concerned, we get the first record of the
systemic knowledge from Vedas. So it is hard to expect any prevedic references
regarding indigenous, medical practices of any kind, so also Raktamokshana.
Vedic Period:
• In the Kaushika Sutra of Atharvaveda, a reference of Raktamokshana from
Jalauka application is found.14
• During the period of Buddha, this procedure was in regular practice, in
Pilindivaccha, Raktamokshan by Shringa for Paravata.14
Samhita period:
Acharya Sushruta and Vagbhata focused on Raktamokshana in detail. In Sushruta
Samhita and Astanga Samgraha we get separate chapters on Siravyadha.
Charakacharya also gives brief description on this topic.
Sangrahakaras period:

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• Siravyadha vidhi is also described by Bhavamishra and Sharangadhara, in the
management of various diseases.15
• In the period of 1200 AD extensive practice of blood letting in many skin
diseases were carried out by unani practitioners.16
• During 1300 AD in Europe there is evidence of raktamokshana are available.17
• King jahangeer was also having the habit of blood letting once in a year.18
• During 18th
century blood letting was done to whom it was understood that all
other said treatments were helpless19
.
• Recently in modern medical science blood letting by venesection(phlebotomy)
advised in the conditions like acute pulmonary oedema, thrombosis of the cerebral
arteries, right heart failure indicated by orthopnoea with distended jugular veins,
cyanosis, venous congestion, in acute pericarditis.20
• In Iron over load states blood letting is the choice of treatment such as in
haemochromatosis, transferrin deficiency,erythropiotic sederosis, porphyria.21
Types of Raktamokshana:
Raktamokshana can be achieved mainly by 2 ways.
1. Shastravisravana and
2. Ashastravisravana.
iÉ§É vÉx§ÉÌuÉxÉëÉuÉhÉÇ Ì²ÌuÉkÉÇ mÉëcNû³ÉÇ ÍxÉUÉurÉkÉlÉqÉç cÉ ||
Shastravisravana is done by either of the ways.22
1. Pracchanna and
2. Siravyadha
............... vÉ×XçaÉeÉsÉÉæMüÉåÅsÉÉoÉÑÍpÉUuÉxÉåcÉrÉåiÉç |

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Ashastra visravana can be carried out by the way of23
1. Shringa
2. Jalauka
3. Alabu and
4. Ghatiyantra, an addition by Vagbhata.
aÉ×ºûÉÌiÉ vÉÉåÍhÉiÉÇ vÉ×XçaÉÇ SvÉÉXçaÉÑsÉÍqÉiÉÇ oÉsÉÉiÉç | eÉsÉÉãMüÉ WûxiÉqÉÉ§ÉÇ iÉÑ iÉÑqoÉÏ cÉ ²ÉSvÉÉXçaÉÑsÉqÉç |
mÉSqÉXçaÉÑsÉqÉÉ§ÉxrÉ ÍxÉUÉ xÉuÉÉïXçaÉvÉÉåÍkÉlÉÏ ||
Application of Shringa can bring out blood from an area of Ten angulis around,
Jalauka can suck from an area of one hasta, Alabu from an area of twelve anguli,
Pracchanna from an area of one anguli, while Siravyadha can purify entire body.24

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SIRAVYADHA
It is a type of Shastrakruta Raktamokshana, in which Shastra is being used to
do Vyadhana of the Sira (the vessel) to let out the blood.
SIRAVARNANA:
Nirukti of Sira:
xÉUhÉÉiÉç ÍxÉUÉ: |25
The srotas which carry substances from one place to another
is called Sira. Siras are called so as it does transport of rasadi dhatus
which flows within it.
Sira Utpatti:
The Vayu, utilizing the snehamsha of medas transforms them into Sira and
Snayu. The Siras arise because of Mrudupaka and Snayu arise from Kharapaka.26
Moola of Sira:
rÉÉuÉirÉxiÉÑ ÍxÉUÉ: xÉqpÉuÉÎliÉ vÉUÏËUhÉÉqÉç |
lÉÉprÉÉÇ xÉuÉÉï ÌlÉoÉÑkSÉxiÉÉ: mÉëiÉuÉÎliÉ xÉqÉliÉiÉ: ||
Those Siras that are found in the Shareera, originate from the nabhi and thence
they spread all over.27
Sira sankhya and Prakara:
xÉmiÉÍxÉUÉ vÉiÉÉÌlÉ pÉuÉÎliÉ |

106.
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 67
There are Seven hundred Siras in the entire body.28
These 700 siras originate
from 40 principle siras. These 40 siras are divided into 4 types as
• Vatavaha Siras: 10
• Pittavaha Siras: 10
• Kaphavaha Siras: 10
• Raktavaha Siras: 10
Of these the Vatavaha Siras, situated in its prime seat ie. Pakwashaya, are
again found to branch out into one hundred and seventy five smaller branches.
Similarly each of the remaining pitta, kapha and rakta vahana siras are found to
branch out in as many numbers as one hundred and seventy five from their prime seat,
thus making 700 in all.
Total Siras in the body:
Vata, Pitta, Kapha and Raktavaha Siras have their branches in Extremities,
Thorax and abdomen and Head and neck in the following fashion.
Siras in Extremeties:
These are twenty five Vatavaha Siras in one extremity and same count applies
to other three extremities, thus making the total of 100. The same is with Pitta, Kapha
and Raktavaha Siras.
Siras in Koshta:
• Guda, Medra Shroni: 8
• Parshwa: 4
• Prushta: 6
• Udara: 6

108.
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 69
Siras in Urdhwajatru:
• Greeva: 14
• Karna: 4
• Jihwa: 9
• Nasika: 6
• Netra: 8
Thus total numbers of Vatavaha Siras are 175, similarly with Pittavaha,
Kaphavaha and Raktavaha Siras, with an exception where the Pittavaha in Netra are
10 each and in karna 2 each.
Table No.27: Showing total no of siras present in the body:
Number of Siras in Shakhas 400
Number of Siras in Koshta 136
Number of Siras in Urdhwajatru 164
Total Siras in Shareera 700
Do’s & Don’t of Siravyadha:
a) Vedhya and Avedhya Siras: Out of the enumerated Siras in the body, for
therapeutic purposes, specific Sira are not to be touched as they result in death or
bodily deformity
A total of 16 Sira out of 400 in the extremities, 32 Sira out of 136 in the
Koshta and 50 out of 164 Siras in the Urdhwajatrugata region should not be taken for
Siravyadha purpose.29

114.
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 75
25 Timira, Akshepaka, adhimanta,
shiroroga
Upanasika sira or
lalata sira or apanga
sira
Upanasika sira or
lalata sira or apanga
sira
26 Jatrudhwa granthi - Greeva, karna,
shankha and
shirastita sira
27 Vataja Shleepada 4 Angula above
Gulpha sandhi
-
28 Pittaja Shleepada Below gulpha
sandhi
-
29 Kaphaja Shleepada 4 Angula above
kshipra marma
-
If the Sira specified are not visible, then the visible Sira near that
area,avoiding marma sthana, should be taken for vyadhana karma.37
Raktamokshana pramana:
oÉÍsÉlÉÉå oÉWÒûSÉåwÉ¶É uÉrÉxjÉ¶É vÉUÏËUhÉ: |
mÉUÇ mÉëqÉÉhÉÍqÉcNûÎliÉ mÉëxjÉÇ vÉÉåÍhÉiÉqÉÉå¤ÉhÉå ||
The bloodletting up to the quantity of one prastha measure is advised for a
rogi who is balavan, vayastha and with bahudosha.38
Acharya Dalhana is of the opinion that the blood can be let out in the
order of one prastha, half prastha and one kudava in case of Uttama, Madhyama and
Adhama matras respectively.
Samyak Viddha Lakshana:
Following features are indicative of properly performed
Siravyadha
xÉqrÉaaÉiuÉÉ rÉSÉ U£üÇ xuÉrÉqÉåuÉÉuÉÌiÉ¸iÉå |

115.
Review of literature
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 76
vÉÑkSÇ iÉSÉ ÌuÉeÉÉlÉÏrÉÉiÉç xÉqrÉÎauÉxÉëÉÌuÉiÉÇ cÉ iÉiÉç ||
During Raktamokshana, when the blood which is flowing freely stops on its
own, it has to be known that shodhana has taken place and is indicative of Samyak
visravana.39
xÉqrÉMçü vÉx§ÉÌlÉmÉÉiÉålÉç kÉÉUrÉÉ rÉÉ xÉëuÉåSxÉ×Mçü |
qÉÑWÕûiÉïÇ ÂkuÉÉÌiÉ¸åccÉ xÉÑÌuÉkSÉ iÉÉÇ ÌuÉÌlÉÌSïvÉåiÉç ||
A well and successfully viddha sira, bleeds in stream and spontaneously
stops after a muhurta.40
rÉjÉÉ MÑüxÉÑÇpÉ mÉÑwmÉåprÉ: mÉÔuÉïxÉëuÉÌiÉ mÉÏÌiÉMüÉ|
iÉjÉÉ ÍxÉUÉxÉÑÌuÉkSÉxÉÑ SÒ¹qÉaÉëå mÉëuÉiÉïiÉå||
The vitiated blood is seen first to flow out of an opened sira, like the drop
of yellow pigment first coming out of a Kusumbha flower.41
sÉÉbÉuÉÇ uÉåSlÉÉvÉÉÎliÉ urÉÉÍkÉuÉåïaÉmÉËU¤ÉrÉ: |
xÉqrÉÎauÉxÉëÉÌuÉiÉå ÍsÉXçaÉqÉç mÉëxÉÉSÉå qÉlÉxÉxiÉjÉÉ ||
Lightness, cessation of pain, decrease in the intensity of vyadhi and
cheerfulness of mind are symptoms of proper blood letting.42
Heena Viddha Karana:
Siravyadha, if done on a cloudy day, if vyadhana is improper, if affected
with cold and breeze, if swedana is not done earlier, and if done after meals, then the
blood having become thick, doesn’t flow out as much as required or flows out in little
quantity. In person suffering from mada, murcha and shrama, who have suppressed

127.
Drug Review
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 109
Charaka emphasized trivrutta as the best herb for sukha virechana. He described
elaborately the different formulations of trivrutta for virechana.He further explained
that it is of two kinds viz., aruna and shyama.Bhavamishra also quoted two varieties
as shweta and shyama.
Chemical constituent: alpha and beta turpethins, scopoletin, turpethinic acid A,
turpethin,coumarin.

128.
Materials and Methods
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 110
CLINICAL STUDY
The clinical study plays a pivotal role in the field of research. So here is a clinical
study entitled “EFFICACY OF SIRAVYADHA WITH AND WITHOUT
VIRECHANA IN SHARAD RUTU-A COMPARATIVE STUDY.”Which is under
taken with following Objectives”
1) To study the effect of siravyadha with virechana in sharad rutu.
2) To study the effect of siravyadha without virechana in sharad rutu.
3) To compare the efficacy of siravyadha with and without virechana in sharad
rutu.
Source of data:
The present study is a clinical trial which will be conducted on volunteers who fulfills
the inclusion criteria from the G.A.M.C. campus.
Method of collection of data:-
30 volunteers presenting with the pitta and rakta prakopaka laxanas are selected
irrespective of sex, religion, age, and economic status.
Inclusion criteria:
• Volunteers between the age group of 16 to 70 years.
• Volunteers having pitta and rakta prakopaka laxanas.
• Volunteers having normal values of clotting and bleeding time.
• Virechana yogya
• Raktamokshana yogya

130.
Materials and Methods
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 112
Group B
Table No.46: Showing the study design of group B
Procedure Duration
Poorva Karma Pachana and Deepan
Snehana
Abhyang and Sweda
Till Niramavastha
For 2 days
For 1 day
Pradhana Karma Siravyaha Once
Paschat Karma :
The Volunteers were asked to take rest for 10-15 minutes and fluid (lemon water) was
given to drink.
Then they will be adviced for Laghu and Deepaniya Aahara.
Materials required for the study:
Drugs
Jeerakadi churna
Murchit ghrit
Tila taila
Trivrutta leha
Yavagu

132.
Materials and Methods
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 114
Present throughout day : 3
KANDU:
(As per the six parts of the body i.e. Shadang, trunk, head, neck,two upper
extremities, two lower extremities)
Absent-0
Presence in any of two-1
Presence in any two to four-2
Presence in more than four-3
Objective parameters:
PITIKA: (Depending upon the number of Pitikas)
Absent-0
0 to 5 in number-1
5to 10 in number-2
More than 10 in number-3
MUKHAPAKA: (As per the involvement of the Buccal mucosa, Tounge, Palate)
Absent-0
Anyone-1
Any two-2

133.
Materials and Methods
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 115
All-3
Jeerakadi Churna : All the contents of jeerakadi churna were collected from the
shop “Amrut kesari depot” Avenue road, near K.R. Market and Bangalore medicals
dhanwantri road,bangalore. Then jeerakadi churna was prepared according to classics
and used for the purpose of Nirameekarana and Agni deepana.
Murchit Ghrita :-
Ghrita is obtained from market and processed with the drugs explained in ghrit
murchana vidhi.
Tila taila : Market sample of taila was used for Sarvanga abhyanga.
Trivrth leha:For the purpose of the study Trivrth leha obtained from The Arya
vaidhya Pharmacy Ltd was used. Reference from Ashtanga Hridayam.
PLAN OF STUDY
Group A:
Poorvakarma:
All necessary equipments should be arranged. All necessary drugs as Deepana
Pachana drugs, Virechana yoga, Drugs for emergency such as Karpur rasa,
Sutashekhar, Kutajaghana vati etc. should be collected in sufficient quantity according
to Atura and Roga.
Prior to procedure the detailed examination of the patient is done according to
Dosha, Desha, Kala, Bala, Shareera, Ahara, Satmya, Satva, Prakruti and Vaya.

134.
Materials and Methods
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 116
Amapachana: Here jeerakadi churna was chosen, The churna was administered as
long as Nirama lakshanas are seen.
Snehapana:
After appearance of Nirama lakshana murchita Ghrita was administered for the
purpose of Sneha Pana. Sneha Pana was done in between 6.30 -7 am and Ushna Jala
Anupana was given. The Sneha Pana was started with Hrisiyasi Matra i.e 30 ml
.Then according to the symptoms presenting in the individual, the duration taken to
digest the given dose of Sneha, the time of appearance of appetite in the patient , the
next day dose was decided.
In this pattern Arohana karma Snehapana was followed until the appearance of
Samyak Snigdha Laxanas. Patients were advised to avoid exposure to wind , sunlight,
emotional upsets, heavy work, excessive talking, laughing , standing for long time ,
journey , intake of heavy meals, night waking , day sleep, cold comforts.
Patients were properly educated about the Laxanas which may appear during
digestion of Sneha, after digestion.
Patients were advised to take only hot water in little quantity till Sneha Jeerna
Laxanas appears.
When patient noticed strong sensation of hunger advised to take the gruel Rice, Ragi,
or Rava according to their food habit.
When the samyak snigdha laxanas were observed, the intake of ghee was stopped.

135.
Materials and Methods
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 117
Assesment of Samyak Snighdha Laxanas
Vatanulomana- assessed by the normal expulsion of the flatus, feces.
Deeptagni- Based on the time taken for digestion of sneha
Asamhata varchas- based on the consistency of the feces .i e stool will be
loose in consistency
Snigdha varcha- confirmed based on nature of stool. Stool will be sticky or
pasty , floating of feces over water, Sense of oiliness over the fingers on
washing after defecation
Twak snigdhata- it is assessed by comparing the texture of the skin, before and
after Sneha pana.
Glani- assessed by presence of exhaustion or weakness
Angalaghava- By enquiring with the patient about lightness of the body.
Snehodhvega- Confirmed by the aversion of the patient towards Sneha
Adastath sneha darshana-Appearance of sneha in stool without digestion
Swedana: Whole body Abhyanga with lukewarm Tila Taila was done for 30 mins.
in 7 positions . Then patients made to under go parisheka Sweda till the appearance
of perspiration. Abhyanga and Swedana were administered on the gap day, and also
on the day of Virechana just prior to the procedure.
Virechana: The Trivrutta leha was given in dose of 40 gm to volunteer with
Sukoshana Jala Anupana.
• The volunteer are asked about the digestion of previous day meal, sleep
and observing his mental condition, After assessing the psychological
condition of the patient.

136.
Materials and Methods
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 118
• Trivrutta leha was given in empty stomach. In the morning around 8.30
a.m to 9.00 a.m Virechana yoga was given.
• Just after administration of Virechana yoga cold water was sprinkled on
the face to prevent vomiting.
• The patient was asked to gargle with hot water.
• Patients were protected from direct cold wind.
• Patients were advised to avoid Pravahana.
• Hot water was given frequently.
Nireekshana: Observation of the patient was made for assessing the number of vegas,
samyak virikta lakshanas and kaphanta of virechana vega.
Paschat karma: After virechana vega is stopped, by observing the avara, madhyama
and pravara shuddhi, samsarjana karma was adviced to bring agni to its normalcy.
Thin rice ganji,thick rice ganji,rice, rice with oil and salt and then normal diet was
advised.when volunteers reached to normal diet then gap of one day was given. Next
day onwards snehapan started for siravyadha.
Snehapana: Murchita Ghrita was administered for the purpose of Sneha Pana.
Sneha Pana was done in between 6.30 -7 am and Ushna Jala Anupana was given.
Sneha was administered for two days , first day 30 ml and second day 60 ml.
Swedana: Whole body Abhyanga with lukewarm Tila Taila was done for 30 mins.
in 7 positions . Then patients made to under go parisheka Sweda till the appearance
of perspiration, on the day of siravyadha.

137.
Materials and Methods
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 119
Pradhana Karma:Yavagupana was done before doing the siravyadha. The patient
was made to sit comfortably over the examination table. With their both hands firmly
kept sideway of body. Then the part was cleaned with surgical spirit.
A tourniquet was tied, neither too tight nor too loose, above the right elbow
joint to make the Sira prominent and if essential, mild blow was given over the Sira.
The sterile Scalp vein set of 18 gauze was taken and needle was introduced
into the Sira (vein).
When the needle of the Scalp vein set was in situ, the other end of the set was
kept in the kidney tray for collection and to assess the quantity let out, which ranged
between 30ml-120ml.
Careful observation of patient was made during the procedure for vital
parameters.
Paschat Karma:
After letting out sufficient quantity of blood, the needle was taken out, sterile
cotton pad was kept and bandaged.
The patient was asked to take rest for 10-15 minutes and fluid (lemon water)
was given to drink.
Group B:
Amapachana: Here jeerakadi churna was chosen, The churna was administered as
long as Nirama lakshanas are seen.
Snehapana:

138.
Materials and Methods
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 120
After appearance of Nirama lakshana murchita Ghrita was administered for the
purpose of Sneha Pana. Sneha Pana was done in between 6.30 -7 am and Ushna Jala
Anupana was given. Sneha was administered for two days , first day 30 ml and
second day 60 ml.
Swedana:
Whole body Abhyanga with lukewarm Tila Taila was done for 30 mins. in 7
positions . Then patients made to undergo parisheka Sweda till the appearance of
perspiration, on the day of siravyadha.
Pradhana Karma:
Yavagupana was done before doing the siravyadha. The patient was made to
sit comfortably over the examination table. With their both hands firmly kept sidewise
of body. Then the part was cleaned with surgical spirit.
A tourniquet was tied, neither too tight nor too loose, above the right elbow
joint to make the Sira prominent and if essential, mild blow was given over the Sira.
The sterile Scalp vein set of 18 gauze was taken and needle was introduced
into the Sira (vein).
When the needle of the Scalp vein set was in situ, the other end of the set was
kept in the kidney tray for collection and to assess the quantity let out, which ranged
between 30ml-120ml.

139.
Materials and Methods
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 121
Careful observation of patient was made during the procedure for vital
parameters.
Paschat Karma:
After letting out sufficient quantity of blood, the needle was taken out; sterile
cotton pad was kept and bandaged. The patient was asked to take rest for 10-15
minutes and fluid (lemon water) was given to drink.

140.
Observations
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 122
OBSERVATIONS
A total of 45 subjects were screened for the study, out of which 38 met the
inclusion criteria. A total of 38 subjects were registered for the present study. 18
were registered in group A, 3 dropped out in the middle, while 20 were registered in
Group B, and 5 dropped out in the middle
All the subjects were examined before and after the Shodhana according to the
case sheet format given in the appendix. Changes in both the subjective and objective
parameters were recorded.
INCIDENCE OF SEX:
Table No47. Showing the incidence of sex in 30 subjects
Sex Group A Group B Total %
Male 11 12 23 77
Female 4 3 7 33
Graph no.1: Showing the incidence of sex in 30 subjects
SEX: It has been observed that among 30 subjects, 23(77%) were males and 7(33%)
were females.

141.
Observations
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 123
Table No48. Showing the incidence of subjects who were taken under study
SL.No Taken Dropouts
Group A 18 3
Group B 20 5
Graph 2: Showing the incidence of subjects who were taken under study
Drop Out: In this study 38 subjects were registered. All the patients were randomly
grouped into 2 groups. Out of these 38 subjects, 6 discontinued and 2 were not
include because of complication.
Table No49. Showing age wise distribution.
Age
Group
A
Group
B
Total %
16 - 19 1 0 1 3%
20 – 29 12 5 17 57%
30 – 39 1 6 7 24%
40 – 49 1 2 3 10%
50 – 59 1 1 3%
60 – 70 1 1 3%

146.
Observations
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 128
RELIGION: Among the 30 subjects randomly incorporated into the study
25(83.33%) belonged to Hindu community and rest 5(16.66%) were Muslim.
Table No.56: Showing the incidence of Addictions.
Habits
Group
A
Group
B
Total %
Smoking 2 1 3 10
Alcohol 1 3 4 13.33
Smoking and
Alcohol
3 2 5 16.66
Tobacco 0 1 1 3
Nil 9 8 17 57
Graph no.10: Showing the incidence of Addictions.
ADDICTIONS: It has been observed that 13(43%) were having addictions. And
17(57%) were not having any addictions among the 30. 4 (13.33%) out of 30 were
addicted to Alcohol, 3(10%) out of 30 were smokers, 5 (16.66%)out of 30 were both
alcoholic and smokers whereas 1(3%) was addicted to tobacco.

153.
Observations
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 135
Table No.:64 Showing distribution of Time of initiation of Vegas in Group A
Time of initiation of
vegas
Group
A
%
<1/2 hr 0 0.00%
½-1hr 5 33.33%
1-1 ½ hr 9 60.00%
>1 ½ hr 1 6.67%
Graph no 16.: Showing distribution of Time of initiation of Vegas in Group A
Time of intiation of vegas after the intake of virechana aoushada: In Group A,
majority of subjects 9(60%) , the vega was started between 1-1 ½ hr,5( 33.33%)
between ½ - 1hr and in 1 it was after 1 ½ hr.
Table No.:65 Showing of vegas attained .
Vegas Group A %
0-10 0 00
11-20 12 80
21-30 3 20

155.
Observations
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 137
In Group A , among 15, 6 (40%) got complete laigiki shudhi, 5(33.33%) got 5-6
lakshanas and 4( 26.67%) got 3-4 lakshanas.
Table No.68: Showing distribution of Duration of flow in both the groups.
Duration Group A % Group B %
2 min 30sec -3min 3 20 0 0
3min 1sec-3min30sec 3 20 7 46.66
3min31sec-4min 5 33.33 1 7
4min1sec-4min30sec 4 26.66 7 46.66
Graph no.19: Showing distribution of Duration of flow in both the groups.
Group A: Out of 15,3(20%) were had a duration in between 2min 30 sec to
3min,3(20%) were in between 3min 1 sec to 3min 30 sec, 5 (33.33%)were in between
3min 31 sec to 4 min, 4(26.66%) were in between 4 min 1 sec to 4min 30 sec.
Group B: Out of 15,0(0%) were had a duration in between 2min 30 sec to
3min,7(46.66%) were in between 3min 1 sec to 3min 30 sec, 1(7%) were in between
3min 31 sec to 4 min, 7(46.66%) were in between 4 min 1 sec to 4min 30 sec.
Table No.69: Showing distribution of Nature of flow in both the groups.
Nature of flow Group A % Group B %
Slow 5 33.33 3 20
Medium 5 33.33 6 40
Rapid 5 33.33 6 40

156.
Observations
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 138
Graph no.20: Showing distribution of Nature of flow in both the groups
Group A: Out of 15 subjects the nature of flow was slow in 5 (33.33%), medium in
5(33.33%) and rapid in 5(33.33%).
Group B: Out of 15 subjects the nature of flow was slow in 3(20%) , medium in
6(40%) and rapid in 6(40%).
Table No.70: Showing distribution of Quantity of let-out blood in both the
groups.
Quantity Group A %
Group
B
%
40ml-65ml 4 26.66 7 46.66
66ml-90ml 5 33.33 2 13.33
91ml-115ml 4 26.66 2 13.33
116ml-140ml 2 13.33 4 26.66
Graph no.21: Showing distribution of Quantity of let-out blood in both the
groups.

157.
Observations
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 139
Group A: The 4(26.66%) were had a quantity in between 40ml-65ml,5(33.33%) were
in between 66ml-90ml,4(26.66%) were in between 91 ml to 115ml and 2(13.33%)
were 116ml-140ml.
Group B: The 7(46.66%) were had a quantity in between 40ml-65ml,2(13.33%) were
in between 66ml-90ml,2(13.33%) were in between 91 ml to 115ml and 4(26.66%)
were 116ml-140ml.
Table No.71: Showing distribution of Sira Utthapan kala after application of
torniquet in both the groups.
Utthapan kala Group A %
Group
B
%
30sec-1min 3 20 1 6.66
1min1sec-1min30sec 5 33.33 7 46.66
1min31sec-2min 5 33.33 4 26.66
2min1sec-2min30sec 2 13.33 3 20
Graph no.22: Showing distribution of Sira Utthapan kala after application of
torniquet in both the groups.

158.
Observations
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 140
Group A: Out of 15,3(20%) were had a duration in between 30 sec to
1min,5(33.33%) were in between 1min 1 sec to 1min 30 sec, 5(33.33%) were in
between 1min 31 sec to 2 min, 2(13.33%) were in between 2 min 1 sec to 2min 30
sec.
Group B: Out of 15, 1(6.66%) had a duration in between 30 sec to 1min,7(46.66%)
were in between 1min 1 sec to 1min 30 sec, 4(26.66%) were in between 1min 31 sec
to 2 min, 3 (20%)were in between 2 min 1 sec to 2min 30 sec.

159.
Observations
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 141
Table No.72: Showing distribution of Bleeding time in both the groups.
Bleeding time Group A %
Group
B
%
30sec-1min 0 00 0 00
1min1sec-1min30sec 2 13.33 8 53.33
1min31sec-2min 7 46.66 3 20
2min1sec-2min30sec 6 40 4 26.66
Graph no.23: Showing distribution of Bleeding time in both the groups.
Group A: Among the 15,2 (13.33%)were in between 1min 1 sec to 1min 30 sec,
7(46.66%) were in between 1min 31 sec to 2 min, 6(40%) were in between 2 min 1
sec to 2min 30 sec.
Group B: Among the 15, 8(53.33%) were in between 1min 1 sec to 1min 30 sec,
3(20%) were in between 1min 31 sec to 2 min, 4(26.66%) were in between 2 min 1
sec to 2min 30 sec.
Table No.73: Showing distribution of Clotting time in both the groups.
Clotting time Group A %
Group
B
%
Up to 1 min 0 00 0 00
1min 1sec-2min 0 00 0 00
2min1sec-3min 0 00 0 00
3min1sec-4min 9 60 10 66.66
4min1sec-5min 6 40 5 33.33

171.
Results
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 150
RESULT
The effect of therapy on various parameter studied under two headings.
A) Within the groups
B) In between Groups
A) Within the Group
Statistical analysis within group was done by using Wilcoxons sign rank
test
Daha
In Group A
Z Asymp. Sig.(2-tailed) Result
-3.442a
.001 H S
a-Based on positive ranks.
p=0.001 indicates there is highly significant result i.e. decrease in dah after
the treatment.
In Group B
Z Asymp. Sig.(2-tailed) Result
-3.542a
<0.001 H S
P<0.001 indicates there is highly significant decrease in dah after the
treatment.
a-Based on positive ranks.
Vidah
In Group A
Z Asymp. Sig.(2-tailed) Result
-3.402a
.001 H S

172.
Results
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 151
a-Based on positive ranks.
p=0.001 indicates there is highly significant decrease in vidah after the
treatment.
In Group B
Z Asymp. Sig.(2-tailed) Result
-3.557a
<0.001 H S
a-Based on positive ranks.
p<0.001 indicates there is highly significant decrease in vidah after the
treatment.
Kandu
In Group A
Z Asymp. Sig.(2-tailed) Result
-3.494a
<0.001 H S
a-Based on positive ranks.
p<0.001 indicates there is highly significant decrease in kandu after the
treatment.
In Group B
Z Asymp. Sig.(2-tailed) Result
-3.626a
<0.001 H S
a-Based on positive ranks.
p<0.001 indicates there is highly significant decrease in kandu after the
treatment.
Mukhapak
In Group A
Z Asymp. Sig.(2-tailed) Result
-3.360a
.001 H S
a-Based on positive ranks.

173.
Results
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 152
p=0.001 indicates there is highly significant decrease in mukhapak after
the treatment.
In Group B
Z Asymp. Sig.(2-tailed) Result
-3.638a
<0.001 H S
a-Based on positive ranks.
p<0.001 indicates there is highly significant decrease in mukhapak after
the treatment.
Pitika
In Group A
Z Asymp. Sig.(2-tailed) Result
-3.384a
.001 H S
a-Based on positive ranks.
p=0.001 indicates there is highly significant decrease in pitika after the
treatment.
In Group B
Z Asymp. Sig.(2-tailed) Result
-3.606a
<0.001 H S
a-Based on positive ranks.
p<0.001 indicates there is highly significant decrease in Pitika after the
treatment.

176.
Results
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 155
There was a significant decrease in Dah after Shodhana in both groups
using Wilcoxons test. However there was a significant decrease in Dah in
Group A as compared to Group B on Mann Whitney test.
Test statistics
Between Groups
Dah change
Mann-Whitney U 35.000
Wilcoxon W 155.000
Z -3.401
Asymp. Sig. (2-tailed) .001
Statistical analysis shown that the parameter Dah showed highly
significant result as p=0.001 in between the groups.
• Comparison of mean score of the parameter Vidah in Group A and
Group B using Mann Whitney test.
Table No.80: Showing the Mann whitney for the parameter vidah.
Group Vidah B.T. Vidah A.T. Vidah Change
Group A
Mean±SD
N=15
2.36±0.633 .43±0.514***
1.93±0.615+++
Group B
Mean±SD
N=15
2.33±0.49 1.27±0.594***
1.067±0.458+++

177.
Results
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 156
***
p value for Wilcoxons,+++
p value for Mann Whitney test
Graph No27: Showing the Mann whitney for the parameter vidah.
There was a significant decrease in Vidahah after Shodhana in both groups
using Wilcoxons test. However there was a significant decrease in Vidah
in Group A as compared to Group B on Mann Whitney test.
Test statistics
Between Groups
Vidah change
Mann-Whitney U 33.000
Wilcoxon W 153.000
Z -3.497
Asymp. Sig. (2-tailed) <0.001
Statistical analysis shown that the parameter Vidah showed highly
significant result as p<0.001 in between the groups.
• Comparison of mean score of the parameter Kandu in Group A and
Group B using Mann Whitney test.

178.
Results
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 157
Table No.81: Showing the Mann whitney for the parameter kandu
Group Kandu B.T. Kandu A.T. Kandu Change
Group A
Mean±SD
N=15
2.29±0.611 .50±0.519***
1.79±0.42582+++
Group B
Mean±SD
N=15
2.67±0.49 1.47±0.640***
1.2±0.41404+++
***
p value for Wilcoxons,+++
p value for Mann Whitney test
Graph No.28.: Showing the Mann whitney for the parameter kandu
There was a significant decrease in Kandu after Shodhana in both groups
using Wilcoxons test. However there was a significant decrease in Kandu
in Group A as compared to Group B on Mann Whitney test.
Test statistics
Between Groups
Kandu change

180.
Results
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 159
Graph No.29: Showing the Mann whitney for the parameter
mukhapak.
There was a significant decrease in Mukhapak after Shodhana in both
groups using Wilcoxons test. However there was a significant decrease in
Mukhapak in Group A as compared to Group B on Mann Whitney test.
Test statistics
Between Groups
Mukhapak change
Mann-Whitney U 41.000
Wilcoxon W 161.000
Z -3.246
Asymp. Sig. (2-tailed) .001
Statistical analysis shown that the parameter Mukhapak showed highly
significant result as p=0.001in between the groups
• Comparison of mean score of the parameter Pitika in Group A and
Group B using Mann Whitney test.
Table No.83: Showing the Mann whitney for the parameter pitika
Group Pitika B.T. Pitika A.T. Pitika Change
Group A
Mean±SD
N=15
1.86±0.663 .14±0.363***
1.7143±0.61125+++
Group B
Mean±SD
N=15
2.00±0.655 1.13±0.640***
.8667±0.35187+++

181.
Results
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 160
***
p value for Wilcoxons,+++
p value for Mann Whitney test
Graph No.30: Showing the Mann whitney for the parameter pitika.
There was a significant decrease in Pitika after Shodhana in both groups
using Wilcoxons test. However there was a significant decrease pitika in
Group A as compared to Group B on Mann Whitney test.
Test statistics
Between Groups
Pitika change
Mann-Whitney U 32.500
Wilcoxon W 152.500
Z -3.677
Asymp. Sig. (2-tailed) <0.001
Statistical analysis shown that the parameter Pitika showed highly
significant result as p<0.001 in between the groups.
Statistical Analysis of Procedure Assessment:

182.
Results
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 161
Comparison of mean scores for duration of flow, nature of flow and quantity of flow
of blood ,in Siravyadha followed by Virechana and Siravyadha alone.
Table No.84: Showing the statistical analysis of duration of flow,nature of flow,
and quantity.
Group Duration of Flow in
min
Nature of Flow Quantity in ml
Group A
Mean±SD
N=15
3.57±0.56 1.93±0.83 85±25.3
Group B
Mean±SD
N=15
3.71±0.51 2.2±0.78 87±36.3
Graph No31 .: Showing the statistical analysis of duration of flow,nature of flow,
and quantity.
Independent samples Mann Whitney tests between groups for duration of flow .
0
20
40
60
80
100
Dur.of
flow
Nat. of
flow
Quantity
Group A
Group B

186.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 164
Discussion
Conceptual Part:
Discussion on Virechana:
iÉ§É SÉåwÉWûUhÉÇ AkÉÉåpÉÉaÉÇ ÌuÉUåcÉlÉ xÉÇ¥ÉMüqÉç |
The act of expelling vitiated doshas (malas) through Adhobhaga is known as
Virechana.Virechana is the purificatory measure especially used for the elimination of
vitiated pitta dosha. All the Acharyas underlined its importance in the management of
pitta dosha.
In Charaka samhita, while explaining Agryaoushada stated as, ÌuÉUåcÉlÉqÉç
ÌmÉ¨ÉWûUÉhÉÉÇ ´Éå¹qÉç”||. The guna of virechana dravya are ushna, teekshna, sukshma,
vyavayi, vikashi, these qualities are common in vamana aoushadam, but virechana
dravya has adhobagahara prabhavam.Virechana dravya has jala and prithwi
mahabootha predominance. It is also useful in the conditions such as pitta
associated,with kapha, Kapha displaced to vatasthana ‘ÌmÉ¨Éå iÉÑ ÌuÉUåMüqÉç,zsÉåwqÉ xÉÇxÉë×¹å
uÉÉiÉxjÉÉlÉ aÉiÉå uÉÉ zsÉåwqÉÍhÉ CÌiÉ||
Pitta is mala of rakta –“ÌmÉ¨É iÉÑ xuÉåS U£ürÉÉå:” So it can be indicated in raktavaha srotho
vikara and virechana is also indicated for raktapradoshaja vikaras.
Acharya Charaka, while explaining about treatment of Pitta vikara stated as-ÌuÉUåcÉlÉqÉç
iÉÑ xÉuÉÉåïmÉ¢üqÉåpÄrÉ: ÌmÉiÉå mÉëkÉÉlÉiÉqÉèû qÉlrÉliÉå ÍpÉwÉeÉÈ”||.
Classification of Virechana dravyas:
The drugs which produce virechana are classified into many types based on
their origin, mode of action, parts used, according to seasons and kalpana. Acharya

187.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 165
Sharangadhara has given a unique classification as Anulomana, Bhedana, Sramsana,
Rechana.
According to seasons, different virechaka drugs are used in different season.
Among all the drugs, Trivrutta is safe and can be used in all seasons. These virechaka
yogas can be prepared in many forms like Gritha, Taila, and Avalehya etc. This is
according to convenience and for easy palatability.
Depending on the Koshta of the patient dosage can be fixed. Acharya
Sharangadhara has given dosage of Kwatha, Kalka and Choorna.
Procedure Review:
Virechana karma has been studied under 3 headings, Poorva Karma, Pradhana karma
and Paschat karma.
Poorva Karma:-
In Purvakarma Pachana-Deepana, Snehana, Swedana are to be done. Aampachana
and agnideepti are the two essential aspects before the administration of sneha. Here
in snehapana, ghrita or taila reaches the cellular level and does the shithilata of
vitiated doshas.Swedana helps to bring them into koshtha for elimination.
Pachana -Deepana
This preparatory procedure aims at Niramikarana.For the administration of snehapan
Niramikaran is essential, as snehapana in amavastha leads to many complications.
Snehapana: This is one of the very important stage in shodhana procedure.
Administration of sneha does the dosha vilayana and moistens the strotas.
Swedana:The doshas which are present all over body brought to koshtha by swedana.
Hence swedana helps for elimination of vitiated doshas through shodhana procedure
by bringing them to koshtha.

188.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 166
Pradhana karma:
This is the most important aspect of shodhana by Virechana. This includes the
administration of Virechana drug to the person. The care should be taken to avoid any
vyapat, and if occurs that must be treated carefully.
In the Pradhana karma, virechaka yoga is given, it gets digested and enters the
systemic circulation, which increases the peristalsis and eliminates the vitiated doshas
(malas). For assessment of virechana, vaigiki, manaki, antaki, and laingiki lakshanas
are taken, where laigiki is given more importance.
Assessment of Virechana
Vaigiki Shudhi:- helps to decide whether Shudhi is Pravara , Madhyama , Avara and
plan the Samsarjana Krama accordingly.
Maniki Shudhi:- helps to decide whether Shudhi is Pravara , Madhyama , Avara and
gives idea about the Quantity of Doshas expelled and Quantity of the remnant if any.
Antiki Shudhi: - valuable criteria to make decision about end point of Virechana. It
gives idea to physician from proceeding further and leading to Ati yoga or Vyapath.
Laingiki Shudhi:This is important among the all. It shows the effect of procedure over
human body and calamities.
Paschat Karma: It includes samsarjana karma, after Shodana, the Agni becomes
diminished, hence it is brought to normal by samsarjana karma. This depends on the
type of shuddhi achieved. Depending upon the pravara,madhyama and avara shudhi
samsarjana karma has to be planned.
Discussion on Raktamokshana:Raktamokshana is one among the
shodhanakarma according to Acharya Sushruta and Vagbhata. Charaka has also
mentioned the procedure Raktamokshana but not considered it under Panchakarma.

189.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 167
Raktamokshana can be achieved mainly by 2 ways.Shastravisravana and
Ashastravisravana.Shastravisravana is done by either of the ways. Pracchanna and
Siravyadha iÉ§É vÉx§ÉÌuÉxÉëÉuÉhÉÇ Ì²ÌuÉkÉÇ mÉëcNû³ÉÇ ÍxÉUÉurÉkÉlÉqÉç cÉ ||
Ashastra visravana can be carried out by the way of Shringa, Jalauka Alabu and
Ghatiyantra
Efficacy of each method:
Application of Shringa can bring out blood from an area of Ten angulis
around, Jalauka can suck from an area of one hasta, Alabu from an area of
twelve anguli, Pracchanna from an area of one anguli, while Siravyadha can
purify entire body.
SIRAVYADHA
It is a type of Shastrakruta Raktamokshana, in which Shastra is being used
to do Vyadhana of the Sira (the vessel) to let out the blood.
Sira sankhya and Prakara:
There are Seven hundred Siras in the entire body. These 700 siras originate
from 40 principle siras. These 40 siras are divided into 4 types as, Vatavaha Siras:10,
Pittavaha Siras:10 Kaphavaha Siras:10 Raktavaha Siras:10
Siras in Extremeties:These are twenty five Vatavaha Siras in one extremity and
same count applies to other three extremities, thus making the total of 100. The same
is with Pitta, Kapha and Raktavaha Siras.
Siras in Koshta: Guda, Medra, Shroni:8 Parshwa:4 Prushta:6 Udara:6 Vaksha:10
Siras in Urdhwajatru:Greeva:14, Karna:4, Jihwa:9, Nasika:6, Netra:8
Thus total numbers of Vatavaha Siras are 175, similarly with Pittavaha,
Kaphavaha and Raktavaha Siras, with an exception where the Pittavaha in Netra are
10 each and in karna 2 each.

190.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 168
Avedhya Sira: A total of 16 Sira out of 400 in the extremities, 32 Sira out of 136 in
the Koshta and 50 out of 164 Siras in the Urdhwajatrugata region should not be taken
for Siravyadha purpose.
Vedhya Sira: A total 602 sira out of 700 are vedhya in which Shakhagata are 384,
Koshtagata are 104, Urdhwajatrugata are 114.
Siravyadha Procedure:
iÉ§É ÎxlÉakÉÎxuÉ³ÉqÉÉiÉÑUÇ rÉjÉÉSÉåwÉmÉëirÉlÉÏMüÇ SìuÉmÉëÉrÉqÉç A³ÉqÉç pÉÑ£üuÉliÉÇ rÉuÉÉaÉÔÇ mÉÏiÉuÉliÉÇ uÉÉ
The patient, after snehana, swedana should be given ahara or Yavagu, at
appropriate time, and should be asked to sit or stand comfortably. Selecting the area,
the Sira are made prominent with the help of either vastra, patta, charma,
antharvalkala, latha tied neither too hard nor too loose. Such uttita Sira are taken for
vyadhana karma with the shastras mentioned.
Samyak Viddha Lakshana:
Following features are indicative of properly performed Siravyadha
During Raktamokshana, when the blood which is flowing freely stops on its
own, it has to be known that shodhana has taken place and is indicative of Samyak
visravana. A well and successfully viddha sira, bleeds in stream and spontaneously
stops after a muhurta.The vitiated blood is seen first to flow out of an opened sira, like
the drop of yellow pigment first coming out of a Kusumbha flower.Lightness,
cessation of pain, decrease in the intensity of vyadhi and cheerfulness of mind are
symptoms of proper blood letting.
There are 4 methods of preventing excess bleeding: Sandhana, Skandana, Pachana,
Dahana.
Discussion on Rutu: In Yajurveda we come across the description of six rutus and
their respective months. Madhu Madhav –Vasant rutu,Shukra Shuchi-Greeshma rutu,

191.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 169
Nabha nabhasya- Varsha, Isha Urja –Sharad, Saha Sahasya-Hemant, Tapa Tapasya-
Shishira. The same description has been followed by all the Ayurvedic classics. But
while explaining the rutus for application of shodhana procedure they are classified as
Vasant, Greeshma, Pravrut, Varsha, Sharad, Hemant.While Chakrapani commented as
this classification varies according to southern and northen area of river Ganga.
In Shathapatha Brahman rutus are classified as Deva rutu and Pitru rutu.
ME ASURES TO BE ADOPTED AS PER RUTUS:
Gopatha Brahman:The diseases are going to manifest during rutusandhi,hence yagnya
has to be perform during this period.
Jaiminiya Brahman:During sandhikala there is elaboration of ashwini ukth.
shathapatha Brahman:the Brahman has to perform yagnya during vasant
rutu,kshatriya during greeshma,and vaishya during varsha rutu.
Aapastambha kshoutrasutra. The yagnya has been told as per the rutus,
Vasant-vaishwadevyagnya,Pravrut-arunpraghasyagnya,Sharadshakmedhayagnya.Here
also we come to know about the consideration of sadharan rutu to perform yagnya,
similar to that of Ayurveda which narrate the elimination of doshas as per sadharan
rutu,viz.,Sharad-Pitta,Vasant-Kapha,Pravrut-Vata.
In Charaka Samhita stated that having the administration of purification
therapies in view ,seasons are thus divided into six.There are three rutus pravrut
sharad and vasant which are of moderate nature
Purificatory therapies viz., vaman etc., should be administered only in seasons of
moderate nature. In other seasons having extreme cold ,heat, or rain such therapies
should not be administered .If needed administered with utmost care. The reason
behind this is, the time of other seasons are unsuitable because of the risk of

192.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 170
inadequate or excessive bouts. Ordinary seasons are ideal because of mild degrees of
cold heat and rain during these seasons and so are easy and harmless.
Doshas accumulated in hemant be eliminated in vasant, those accumulated in
greeshma be eliminated in abhrakal and those accumulated in varsha be eliminated in
sharad. And the same principle is elaborated in all the other Ayurvedic classics.
In Astang samgraha stated that Just as slit develops surely, in course of time, even in
pure water kept undisturbed in a earthen pot, so also dirt accumulates inside the body
hence it should be removed from the body at appropriate times.32
In Astang hradaya told that, all our efforts should be made to clear out the
malas(doshas and waste products) at appropriate time ,their accumulation may
become life threatening. Hence the doshas should be removed out of the body as per
their shodhana kala.
Charaka underlined the importance of shodhana as, In case of a poor man in
the event of the administration of the purification therapy should take the prescribed
drugs available without caring for collecting all the rare medicaments in advance. All
the prescribed medicaments are not available to all human beings. At the same time
diseases can attack even poor. So in these circumstances whatever drugs, cloths, diets
are easily available should be used by patients according to their capacity.
SHARAD RUTU CHARYA:
Dos: In this season sweet, light, cold and bitter foods and drinks which have
potentialities to alleviate pitta are to be taken in proper quantity when there is good
appetite.
The meat of common quail,grey partridge, antelope, sheep, wapiti, rabbit, rice, barley,
and wheat are prescribed during this season. Use of garlands made of autumnal
flowers and clean apparel and also the rays of the moon are exceedingly beneficial in

193.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 171
this season. He should drink laja saktu along with water containing sugar or honey.
Person should eat old rice specially the one that matures in sixty days along with a
soup of mudga. Person should consume sweet taste and the juice of vidari, ikshu, and
draksha. Person should drink ghee.
Day time should be spent in sailing in lakes which are full of swans, rows of
humming bees, and blossomed lotus flowers, wearing light and clean dress, garlands,
anointing the body with the paste of ushira,Chandan which is coolant, nights should
be spent on a terrace having good moonlight.
Donts: One should avoid taking sun bath ,vasa(fat), oil and meat of aquatic and
marshy animals, alkaline salt preparations and curd in food. One should not sleep
during day time and should not expose himself to frost and facing wind.
One should avoid irritant, sour, hot, alkaline items in food, day sleep, sun rays, night
awaking.
These all measures are told by Aacharyas to counteract the vitiation of pitta dosha.
But in present era, it is difficult to follow these measures.
SHODHANA IN SHARADA RUTU:
• ÌiÉ£üxrÉ xÉÌmÉïwÉÉmÉÉlÉÇ ÌuÉUåMüÉå U£üqÉÉåYzÉlÉqÉ|| cÉUMü
Pitta which has been accumulated in varsha rutu gets aggravated in sharad
rutu.In order to check the pitta prakopa one should undergo virechana and
raktamokshana-charak
• ÌiÉ£üxrÉ xÉÌmÉïwÉ: mÉÉlÉæUxÉëÑYxÉëÉuÉæ¶É rÉÑÌ£üiÉ:||
uÉwÉÉïxÉÑmÉÍcÉiÉÇ ÌmÉ¨ÉÇ WûUåŠÌmÉ ÌuÉUåcÉlÉæ:|| xÉÑ´ÉÑiÉ
Pitta accumulated in rainy season should be eliminated properly with blood
letting and purgation.-sushruta .

194.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 172
•
zÉxiÉÇ ÌiÉ£üWûÌuÉ:mÉÉlÉÇ ÌuÉUåMüÉå xÉëxÉëÑÌiÉ: xÉSÉ| A¹ÉÇaÉ xÉaÉëÇWû
• iÉ‹rÉÉrÉ bÉëÑiÉÇ ÌiÉ£Çü ÌuÉUåMüÉå
U£üqÉÉåYzÉlÉqÉ| A¹ÉÇaÉ ¾ûSrÉ46
•
zÉUiMüÉsÉå xuÉpÉÉuÉålÉ MÑürÉÉïS U£üxÉëÑÌiÉÇ lÉU:| zÉÉUÇaÉkÉU47
In sharad rutu rakta gets aggravated naturally hence one should undergo
raktamokshana.sharangadhara
•
ÌmÉ¨ÉÉlÉÉÇcÉ ÌuÉUåcÉlÉÇ oÉsÉuÉiÉÉårÉÑ£Çü ÍxÉUÉqÉÉåYzÉlÉqÉ| pÉÉuÉÍqÉ´É 48
•
ÌmÉ¨ÉÉlÉÉÇcÉ ÌuÉUåcÉlÉÇ oÉsÉuÉiÉÉårÉÑ£Çü ÍxÉUÉqÉÉåYzÉlÉqÉ| rÉÉåaÉU¦ÉÉMüU49
In sharad rutu one should undergo siravyadha.
.
DISCUSSION ON MATERIAL AND METHODS
This is a comparative clinical study conducted to assess the efficacy of
Siravyadha with and without Virechana in Sharad rutu. As per the inclusion and
exclusion criterias, the subjects who fulfill the criteria were selected and randomly
divided into two groups. After the Shodhana effects were analysed on 7th
day in both
the groups.
Inclusion criteria: The age limit for Siravyadha is 16 to 70 years therefore the
16yr. to 70yr. age group criteria was taken.
As per the classics the rutushodhana has to be conducted on healthy person.
But without any parameters it is difficult to assess its efficacy, So the pittaprakopak
and raktaprakopaka laxanas appeared in that particular season without any variation in
their routine lifestyle, aahar and vihar was considered for inclusion criteria.

195.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 173
The subjects were scrutinized for normal clotting time, bleeding time,
Virechana yogyata and Raktamokshana yogyata to avoid any complication.
Hematological investigation such as Hb, TC, DC, ESR were carried out to
observe the variations.
Group A: Jeerakadi Churna was administered till Niramavastha followed by
arohana krama snehapan with Murchit goghrut until getting samyaka snigdha
laxanas.Abhyanga with tila taila followed by parisheka sweda(Ushnodak) carried out
for three days. On third day virechana yoga was administered. Depending upon the
shuddhi the samsarjana karma was planned. After two days of completion of
samsarjana karma snehapan with murchit goghrit was done for two days. On the day
of siravyadha abhyanga and parisheka sweda was done.
Group B: Jeerakadi Churna was administered till Niramavastha followed by
snehapan with murchit goghrit for two days. On the day of siravyadha abhyanga and
parisheka sweda was done.
Site of Siravyadha: The site selected for siravyadha was Dakshina Bahu
kurpara sandhigata sira. The siravyadha does the sarvang rakta shuddhi and this site is
also indicated for Yakruta vikara.The yakruta is a raktavahastrotomula .Hence the site
was selected.
Samsarjana Karma: In olden days there were two Aaharkala and in
samsarjana karma also included two aaharkala.However now a days it changes to
three therefore while planning to samsarjana karma three aaharkala were considered.
Snehapan after two days:Followed by virechana and samsarjana karma
snehapan has to be done on 9th
dat i.e. seven day of samsarjana karma and gap of two
days
xÉÇxÉÚ¹pÉ£Çü lÉuÉqÉå ÎlWû xÉÌmÉïxiÉÇ mÉÉrÉrÉåiÉ|

196.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 174
No Pachana and Deepan: In group A after virechana and samsarjana karma
there will be nil formation of aama .therefore before snehapan for siravyadha
pachana-deepan was not done
Snehapan before Siravyadha: iÉ§É ÎxlÉakÉÎxuÉ³ÉqÉÉiÉÑUÇ
Here stated that snehana and swedan should be done before siravyadha.The
snehapan is done for doshavilayana and to bring them to koshtha. In aarohana karma
snehapan, doshavilayana and their movement towards koshtha occur as dose and
duration increases. Here the removal of doshas takes place from shakha(Rakta) only
therefore to achieve the doshavilayan in shakha and prevent their movement towards
koshtha two day of snehapana was done.And on the day of siravyadha swedana was
carried out.
Parisheka sweda: The parisheka sweda is indicated for pitta dosha therefore
selected.
Discussion on the Medicines used:
Jeerakadi Churna: Usually the drugs which does aampachana are ushna, tikshna. In
the present study pitta dosha is having prime imporatance so such kinds of drugs may
not suits directly. In Jeerakadi churna 9 drugs are having laghu ruksha guna,4 are
having laghu tikshna , and rest are having laghu ruksha tikshna, snigdha, ushna guru
snigdha, laghu snigdha, tikshna laghu pichhila, guru ruksha tikshna gunas. In case of
veeryata 15 drugs are having ushna veerya and 9 drugs are having sheet veerya.
Because of such excellent combination our aim to do aampachana without disturbing
pitta gets fulfilled.

197.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 175
Murchita Goghrit: In case of pitta samanya chikitsa told that
xÉÌmÉïwÉÉ xlÉåWûlÉÇ AkÉÉåSÉåwÉWûUhÉqÉç ||
To eliminate the Aamdosha of ghrit the murchana samskar is essential.Therefore for
snehan purpose murchit ghrit was selected.
Trivrutta Leha: Trivrutta is the best drug among all the purgatives. It has less
complication.
Ì§ÉuÉÚixÉÑZÉÌuÉUåcÉlÉÉlÉÉÇ|
In this yoga trivrutta is the only drug of virechana remaining are sita, madhu, twak,
ela, patra.This yoga is hradya having least complication. As there is no addition of
any drastic purgative, this is not going to hamper the strength of person considerably .
Apart from this, In this group siravyadha has to be conduct after virechana so special
consideration was given to bala of person. Hence this yoga was selected to achieve
desired effect i.e. Virechana should happen with least complication and should not
hamper the bala of person.
DISCUSSION ON OBSERVATION:
SEX: It has been observed that among 30 patients, 23(77%) were males and 7(33%)
were females.
AGE: Maximum of patients belonged to middle aged people.1(3%)out of 30 patients
were in 16-19, 17(57%) in 20-29. 7(24%) out of 30 patients belonged to 30-39,
3(10%) in 40-49 ,1(3%) in 50-59and1(3%) in 60-70 age group. Here maximum
number of patient belongs to20-39yr which is the pittapradhan kala.

198.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 176
EDUCATION: Among the 30 subjects 7(24%) had primary education,11(36.5%) had
higher secondary,11(36.5%) had graduation and 1(3%) was illiterate.
OCCUPATION: 7 (24%)out of 30 were students, 11(36%) were under service, 2
(6%)belonged to business, 7(24%) belonged to occupation of labour and3(10%) out of
30 were house wives. This shows that almost all groups of people get influenced by
the effect of season.
SOCIOECONOMIC STATUS: The socioeconomic status of 13(43.5%) were
belonged to middle class and 6(20%) belonged to poor class, 11(36.5%) belonged to
upper middle class.
MARITAL STATUS: Out of 30 subjects, 16(53.33%) were unmarried and
14(46.67%) were married. Here the both married and unmarried get affected almost
equally, shows that marital status has no significant role.
DIET: Out of 30 subjects 16(53.33%) were vegetarian and 14(46.66%) belonged to
mixed diet.
RELIGION: Among the 30 subjects randomly incorporated into the study
25(83.33%) belonged to Hindu community and rest 5(16.66%) were Muslim. This
may be because of dominance of Hindu community in the area where the work had
been carried out.
ADDICTIONS: It has been observed that 13(43%) were having addictions. And
17(57%) were not having any addictions among the 30. 4 (13.33%)out of 30 were
addicted to Alcohol, 3(10%) out of 30 were smokers, 5 (16.66%)out of 30 were both
alcoholic and smokers whereas 1(3%) was addicted to tobacco.
SATVA: Maximum of 15(50%) were having madhyama satva, whereas 4(13.33%)
were having Pravara and 11(36.66%) were having Avara satva. It shows that there

199.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 177
were less person who had a pravara satva.Avara satva person were needed more
councelling whereas Madhyama satva person were needed less councelling.
PRAKRUTHI: Maximum 14(46.66%) belonged to Pitta vata prakruthi, 11(36.66%)
belonged to Pitta kapha prakruthi and 5(16.66%) were from Vata kapha prakruthi.
Here the maximum person shown the dominance of involvement of pittaprakrutti as
14 of pittavata and 11 of pittakapha.The less number of person were belonged to
vatakapha prakrutti.
SARA: 15(50%) were of Madhyama sara and 5(16.66%) from Pravara and
10(33.33%) were of Avara sara.
Time of intiation of vegas after the intake of virechana aoushada: In Group A,
majority of patients 9(60%), the vega was started between 1-1 ½ hr,5( 33.33%)
between ½ - 1hr and in 1 it was after 1 ½ hr.
No. of Vegas in Group A, 12(80%) had madhyama vegas, and 3(20%) had pravara
vegas.
Antiki Shuddhi in Group A, among 15 11(73.33%)had kaphantam, 4(26.66%) had
pittantam.
Laingiki Shuddhi in Group A: Among 15, 6 (40%) got complete laigiki shudhi,
5(33.33%) got 5-6 lakshanas and 4( 26.67%) got 3-4 lakshanas.
Bleeding Time: Group A: Among the 15,2 (13.33%)were in between 1min 1 sec to
1min 30 sec, 7(46.66%) were in between 1min 31 sec to 2 min, 6(40%) were in
between 2 min 1 sec to 2min 30 sec.
Group B: Among the 15, 8(53.33%) were in between 1min 1 sec to 1min 30 sec,
3(20%) were in between 1min 31 sec to 2 min, 4(26.66%) were in between 2 min 1
sec to 2min 30 sec.

200.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 178
Clotting Time: Group A:In this group 9(60%) were had a clotting time in between 3
min 1 sec to 4min and 6 (40%)were had in between 4min 1 sec to 5min.
Group B:In this group 10(66.66%) were had a clotting time in between 3 min 1 sec to
4min and 5(33.33%) were had in between 4min 1 sec to 5min.
Duration of Flow: Group A: Out of 15,3(20%) were had a duration in between 2min
30 sec to 3min,3(20%) were in between 3min 1 sec to 3min 30 sec, 5 (33.33%)were in
between 3min 31 sec to 4 min, 4(26.66%) were in between 4 min 1 sec to 4min 30
sec.
Group B: Out of 15,0(0%) were had a duration in between 2min 30 sec to
3min,7(46.66%) were in between 3min 1 sec to 3min 30 sec, 1(7%) were in between
3min 31 sec to 4 min, 7(46.66%) were in between 4 min 1 sec to 4min 30 sec.
Among the both groups on average the group A was having more bleeding time than
group B whereas the clotting time was almost same, But the duration of flow was
marginally more in group B than group A. As group A received virechana before
siravyadha the vitiation of pitta get decreased. As there is less dushit rakta it flows for
less duration. On contrary the group B had more dushit rakta it flows for more
duration.
Nature of Flow: Group A: Out of 15 subjects the nature of flow was slow in 5
(33.33%), medium in 5(33.33%) and rapid in 5(33.33%).
Group B: Out of 15 subjects the nature of flow was slow in 3(20%) , medium in
6(40%) and rapid in 6(40%).
In group A the nature of flow was equally distributed. In group B in majority the
nature of flow was medium and rapid. This shows that after vene-section dushit rakta
flows rapidally.

201.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 179
Quantity of let out blood: Group A: The 4(26.66%) were had a quantity in between
40ml-65ml,5(33.33%) were in between 66ml-90ml,4(26.66%) were in between 91 ml
to 115ml and 2(13.33%) were 116ml-140ml.
Group B: The 7(46.66%) were had a quantity in between 40ml-65ml,2(13.33%) were
in between 66ml-90ml,2(13.33%) were in between 91 ml to 115ml and 4(26.66%)
were 116ml-140ml.
Here on average the quantity was more in group B than Group A even though the
group B was having less bleeding time..It shows that after vene section the dushita
rakta flows out.
Colour of Rakta:After doing vene section the shyava varna blood flown out initially,
later on the progressively the colour was changing to bright red and cease the flow.
The shyavata was less in rakta let out after virechana .It underline the raktaprasadan
and pitta shodhana action of virechana.
Sira Utthapan Kala: Group A: Out of 15,3(20%) were had a duration in between 30
sec to 1min,5(33.33%) were in between 1min 1 sec to 1min 30 sec, 5(33.33%) were in
between 1min 31 sec to 2 min, 2(13.33%) were in between 2 min 1 sec to 2min 30
sec.
Group B: Out of 15, 1(6.66%) had a duration in between 30 sec to 1min,7(46.66%)
were in between 1min 1 sec to 1min 30 sec, 4(26.66%) were in between 1min 31 sec
to 2 min, 3 (20%)were in between 2 min 1 sec to 2min 30 sec.
SYMPTOMS: 100% of the patients had Dah, Vidah, Kandu, Pitika, Mukhapak.
Associated with Dhumodgar20%, Kanthashosha43.33%, Amlavaktrata46.66%,
Mukhashosha16.66%, Swedasrav6.66%, Kotha53.33%, Ushnagata10%,
Tiktasyata60%, Raktamandala23.33%, Annaavipak43.33%, Lavanasyata10%,
Tiktamlodgirana63.33%.

202.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 180
Nidan : 100% were afflicted by suryoptap, 43.33% lavan rasa, 60% amla
rasa%,kulattha 30%,shigru 13.33%, mulaka 30%,mamsa 46.66%,madya
30%,masha90%,dadhi 93.33%,lashuna10%,diwaswapna 13.33%.
Samyaka Viddha Laxanas: Group A: Among the 15, 3(20%)were had 2 lakshanas,
8(53.33%) had 3 lakshanas, 4(26.66%)had 4 lakshanas
Group B: Among the 15, 2(13.33%) were had 2 lakshanas, 6(40%) had 3 lakshanas,
7(46.66%)had 4 lakshanas.
Hematological: In Hematological analysis Hb., total count, differential count there
was no significant variations. In case of ESR it was significantly increased in letout
blood
DISCUSSION ON RESULTS:
In the present study both group has shown significant result both clinically and
statistically.
Assessment
Dah:
Significant improvement was seen in both the groups, In group A the mean dah was
2.36 before shodhana which reduced to 0.21 after shodhana. In group B the mean dah
was 2.4 before shodhana which reduced to 1.07.
Vidah:
Significant improvement was seen in both the groups, In group A the mean vidah was
2.36 before shodhana which reduced to 0.43 after shodhana. In group B the mean
vidah was 2.33 before shodhana which reduced to 1.27.

203.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 181
Kandu:
Significant improvement was seen in both the groups, In group A the mean kandu was
2.29 before shodhana which reduced to 0.50 after shodhana. In group B the mean
kandu was 2.67 before shodhana which reduced to 1.47.
Mukhapak:
Significant improvement was seen in both the groups, In group A the mean
mukhapak was 1.86 before shodhana which reduced to 0.07 after shodhana. In group
B the mean mukhapak was 1.87 before shodhana which reduced to 0.87.
Pitika:
Significant improvement was seen in both the groups, In group A the mean pitika
was 1.86 before shodhana which reduced to 0.14 after shodhana. In group B the mean
pitika was 2.0 before shodhana which reduced to 1.13.
There was a significant decrease in all the parameters in both groups.
However there was a significant decrease in Group A as compared to Group B
on Mann Whitney test,
Procedure Assessment:
Duration of flow:
The mean duration was 3.57 min in group A,and 3.71 min in group B.
Among the both groups on average the group A was having more bleeding time than
group B whereas the clotting time was almost same, But the duration of flow was
marginally more in group B than group A . As group A received virechana before
siravyadha the vitiation of pitta get decreased. As there is less dushit rakta it flows for
less duration. On contrary the group B had more dushit rakta it flows for more
duration.

204.
Discussion
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 182
Nature of Flow:
The mean nature of flow was 1.93 i.e. slow to medium, in Group A.whereas it was 2.2
i.e. medium to rapid Group B.
In group A the nature of flow was equally distributed. In group B in majority the
nature of flow was medium and rapid. This shows that after vene-section dushit rakta
flows rapidally.
Quantity:
The mean quantity of let-out blood was 85 ml. in group A and it was 87ml. in group
B. Here on average the quantity was more in group B than Group A even though the
group B was having less bleeding time.It shows that after vene section the dushita
rakta flows out.

205.
CONCLUSION
CONCLUSION
1) The description of seasons told in Ayurvedic classics is true till to the date.
2) Pitta gets aggravated by the effect of season in sharad rutu.
3) It is difficult to follow the seasonal regimen in present era because of strain
and stressful lifestyle. Hence the vitiation of doshas occur tremendously.
Therefore to preserve the health and counteract doshic vitiation one should
undergo rutushodhana.
4) Siravyadha followed by virechana and siravyadha alone are beneficial to
eradicate the vitiated pitta dosha . But the siravyadha followed by virechana is
better than siravyadha alone.
5) Clinically and statistically this study was shown good results in subjective and
objective parameters in both the groups.
6) Siravyadha followed by virechana required more duration in comparison with
siravyadha alone.
7) In present busy life style if it is difficult to spare time for virechana and
siravyadha, person can undergo siravyadha alone to counteract vitiation of
pitta.
8) Siravyadha let-out the vitiated blood.
9) Virechana does the raktaprasadan karma.
Suggestions for further study:
• The use of virechana yoga told in sharad rutu.
• Assess the effects of rutushodhana in sharad rutu with including follow-up till
next sharad rutu.
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 183

206.
CONCLUSION
• Assess the effects of shodhana indicated in three shodhana kala viz. pravrut,
vasant,sharad.
• Assess the effect of shodhana over human by conducting trials for longer
duration and over large sample.
• May be included under National Health Programme as a preventive measure.
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 184

207.
Summary
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 185
SUMMARY
The Thesis title ‘Efficacy of Siravyadha with and without Virechana in sharad
rutu –A comparative study”. Consists of –
1) Introductory part regarding the present work and the objective.
2) Review of procedure- It includes the review of virechana, Nirukthi,
Paribasha, classifications, Indication, Contraindications, Procedure, Management of
Complication, if any vyapaths occur.
It includes the review of raktamokshana, Nirukthi, Paribasha, classifications,
Indication, Contraindications, Procedure, Management of Complication, if any
vyapaths occur.
3)Review of rutu includes description of rutus in vedic period, in Ayurvedic
literature and in present era. Detailed description about the measures adopted as per
the rutus, importance of rutushodhana, rutushodhana in sharad rutu and sharad
rutucharya.
4) Review of drugs used in Amapachana, snehapana, virechana and
siravyadha.
5) Description regarding the materials and methods used in present study.
6) Observation and result of the present study, discussion, summary,
conclusion and bibliography.
• The study was conducted on 30 volunteers having pittaprakopaka laxanas, 15
subjects in each group.
• The drugs selected for the study was Jeerakadi Churna for pachana and
deepan, snehapan with Murchit goghrut, Abhyanga with tila taila, parisheka
sweda with ushnodak, this was common in both the groups. Apart from this

208.
Summary
Dept. of P.G studies in Panchakarma, G.A.M.C. Bangalore. Page 186
trivrutta leha was used for virechana in group A. All the drugs used for this
procedure have been explained under the heading of drug review in the first
part of the thesis.
• The clinical study in the beginning describes about the inclusion, exclusion
criteria, study design of both the groups Subjective and objective parameters
on each group were statistically analyzed and systematically presented in
tables.
• The observation and results are discussed.
• The points observed in this study were- By clinically and statistically both
groups were shown good results. But the siravyadha followed by virechana is
having better result than siravyadha alone